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Barclays Official
California
Code of
Regulations
Title 22. Social Security
Complete Title
(continued)
Vol. 29
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Title 22
Social Security
Title Table of Contents
Title 22. Social Security
Table of Contents
Page
Division 1. Employment Development
Department 1
Subdivision 1. Director of Employment
Development 3
Division 1. Unemployment and Disability
Compensation 3
Part 1 . Unemployment Compensation 3
Chapter 1 . General Provisions 3
Article 1. Policy and Interpretation 3
Article 2. General Definitions 3
Chapter 2. Administration 3
Article 1. Employment Development
Department 3
Article 3. California Unemployment
Insurance Appeals Board 9
Article 4. Interstate and Federal
Cooperation 9
Scope or Coverage 18
Employment 18
Employee 20
Excluded Services , 21
Subject Employers 26
Elective Coverage 26
Elections for Financing
Unemployment Insurance
Coverage 31
Financing Unemployment
Insurance Coverage for
Public School Employees 33
Financing Unemployment
Insurance Coverage for
Local Public Entity
Employees 33
Chapter 4. Contributions and Reports 34
Article I . Definitions 34
Article 2. "Wages" the Basis of the
Contribution 34
Article 3. Contribution Rates 43
Article 4. Reserve Accounts 43
Chapter 3.
Article 1.
Article 1.5
Article 2.
Article 3.
Article 4.
Article 5.
Article 6.
Article 7.
Article 5.
Article 6.
Article 7.
Article 8.
Article 9.
Chapter 5.
Article 1 .
Article 1.5.
Article 2.
Article 2.4.
Article 2.7.
Article 3.
Article 4.
Article 5.
Chapter 5.5.
Chapter 5.6.
Chapter 5.7.
Chapter 6.
Chapter 7.
Chapter 8.
Chapter 9.
Article 1.
Article 2.
Chapter 9.5.
Chapter 10.
Page
Transfer of Reserve
Accounts 45
Records, Reports and
Contribution Payments 46
Payment of Reported
Contributions 53
Assessments 53
Reliinds and Overpayments 54
Unemployment Compensation
Benefits 54
Eligibility and
DisqualificaUons 54
Retraining Benefits 94
Computation (Amount and
Duration) 94
Work Sharing Unemployment
Insurance Benefits 94
Irregular or Infrequent Wage
Payments 96.3
Filing, Determination, and
Payment of Unemployment
Compensafion Benefit
Claims 96.4
Overpayments 104.2
Rights of Trainees 106
Unemployment Compensation for
State Employees 106
Unemployment Compensation for
County Employees 107
Unemployment Compensation for
State Higher Education
Employees 107
Financial Provisions 107
Collections 107
Hearing Procedure 109
Pubhc Employment Offices 109
Job Services 109
Appeals 110.1
Employment for Older Workers 113
Violations 113
Page i
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Title Table of Contents
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
Page
Part 2. Disability Compensation 114 Division 2.
Chapter 1 . General Provisions 114 Chapter
Chapter 2. Disability Benefits 116
Page
Work Incentive Programs 132.5
Employment Preparation
Program 1 32.5
Article 1. Eligibility 116
Article 2. Computation (Amount and
Duration) 118
Article 3. Determinations of Continuing
Eligibility 118
Article 4. Filing, Determination and
Payment of Disability
Benefit Claims 118.2
Article 5. Overpayments 123
Article 6. Rights of Trainees 123
Article 7. Rights of Industrially
Disabled Persons 124
Chapter 3. Additional Benefits 124
Chapter 3.5. Prorated Benefits 124
Chapter 4. Contributions 124
Chapter 5. Financial Provisions 124
Article 1. Disability Fund 124
Article 2. Disability Administration
Account 124
Article 3. Disability Benefit Payment
Account 124
Article 4. Extended Liability Account 125
Article 5. Investments in Buildings 125
Chapter 6. Voluntary Plans 125
Chapter 7. Family Temporary Disability
Insurance 131
Part 3. Extended Unemployment
Compensation 1 32.5
Chapter 1.
General Provisions 132.5
Chapter 2. Extended Duration Benefits 132.5
Article 1. Eligibility and
Disqualifications 132.5
Article 2. Computation (Amount and
Duration) 132.5
Article 3. Filing, Determination, and
Payment of Extended
Duration Benefit Claims 132.5
Article 4. Reserve Accounts 132.5
Article 5. Overpayments 132.5
Chapter 4.
Retraining Benefits 132.5
Article 1. Job Search Assistance 132.5
Article 2. Pilot Payment Component 132.5
Division 2.5. Withholding Tax on Wages 132.6
Chapter 1 . General Provisions 1 32.6
Chapter 2. Withholding and Payment of Tax 148
Chapter 3. Withholding Exemptions 153
Chapter 4. Reports, Returns, and
Statements 1 54
Chapter 5. Collections 1 55
Division 3. Employment Services Programs 155
Parti. Employment and Employability
Services 1 55
Chapter 1. General Provisions and
Definitions 1 55
Chapter 1.5. Employment Training Panel 155
Article 1. General Provisions 155
Article 2. Proposal Process 158.1
Article 4. Program Operations 158.1 1
Chapter 2. Job Training Partnership Act
Complaints 158.15
Article 1. General Provisions 158.15
Article 2. Service Delivery Area
Complaint Procedures 158.16
Article 3. Procedures for Requests for
EDD Review or Appeals of
Service Delivery Area
Decisions 158.18
Article 4. Appeals of FDD-Level
Decisions 158.19
Chapter 2.5. Youth Employment and
Development 158.20
Chapter 2.7. California Work-Site Education
and Training Act 158.21
Subdivision 2. California Unemployment
Insurance Appeals Board 159
Chapter 1 . General 1 59
Chapter 2. Field Operations 163
Chapter 3. Appellate Operations 170
Chapter 4. California Unemployment
Insurance Appeals Board —
Conflict of Interest Code 172.2
Page ii
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Title 22
Social Security
Page
California Department of Part 2.
Aging 173
California Department of Aging —
Conflict of Interest Code 173 Subdivision 1.
Title III Programs— Definitions 173 Chapter 1.
Title III Programs — PSAs and Article 1
AAAs 174.1
Article 2.
Designation of PSAs and
AAAs 174.1 A • 1 o
Article 3.
AAAs General Article 4.
Responsibilities 174.4
Area Plans 174.5 ^,
Chapter 2.
AAA Procurement Procedures ... 174.9
Grievance Process 174.12 Chapter 3
Sanctions 174.13
Title III Programs— Program and Chapter 4.
Service Provider Requirements 174.15
General Requirements for
Programs and Service Subdivision 2.
Providers 174.15
Chapter 1.
Information and Assistance 174.15
Multipurpose Senior Centers 174.18 p. ^
Legal Assistance 174.20
Title III C-Elderly Chapter 2. 1 .
Nutrition Program 174.20
Title III Programs— State Subdivision 4.
Hearings 174.24
Office of the State Long-Term Chapter 1 .
Care Ombudsman 174.27
Long-Term Care Ombudsman Chapter 2.
Program Provisions 174.27
Chapter 2.5.
Ombudsman Duties 174.27
Violations and Enforcement 174.27
Planning and Service Areas Chapter 3.
(PSAs) and Area Agencies on Subchapter 1.
Aging (AAAs) 174.28
Title III Programs— State Subchapter 2.
Hearings 174.28 Article 1.
Department of Social Services —
Department of Health Article 2.
Services 175
Department of Social Article 3.
Services — Manuals of Subchapter 3.
Policies and Procedures 175
Title Table of Contents
Page
Health and Welfare Agency —
Department of Health
Services Regulations 175
Health and Welfare Agency 175
Displaced Homemakers
Programs 1 75
Definitions 175
Priority for Services for
Eligible Participants 176
Stipends for Job Training 176
Sliding Fee Schedule:
Workshops 177
Health and Welfare Agency —
Conflict of Interest Code 177
Safe Drinking Water and Toxic
Enforcement Act of 1986 178
Hazardous Substance Cleanup
Arbitration Panel Hearing
Regulafions 201
Administration 201
Department of Social Services —
Conflict of Interest Code 201
Department of Health Services —
Conflict of Interest Code 202
Department of Health Services
Audits and Appeals 202
Insdtutions and Boarding Homes
for Persons Aged 1 6 and Above 206
General Provisions and
Definitions 206
Licensing Agencies 206
Maternity Home Care Program:
Pregnancy Freedom of Choice
Act 206
Adoptions Program Regulations 210
Adoptions Program
Terminology 210
General Requirements 213
Correction, Alteration,
Translation and Reading of
Forms 213
Recruitment — Agency
Adoptions 217
Staffing Requirements 219
Administrative
Requirements 220
Division 1.8.
Chapter 1.
Chapter 2.
Chapter 3.
Article 1.
Article 2.
Article 3.
Article 4.
Arficle 5.
Article 6.
Chapter 4.
Article 1.
ArUcle 2.
Article 3.
Arficle 4.
Arficle 5.
Chapter 5.
Chapter 6.
Arficle 1.
Arficle 2.
Arficle 3.
Chapter 4.
Arficle 7.
Division 2.
Part 1.
Page iii
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Title Table of Contents BARCLAYS CALIFORNIA
Page
Article 1. Administration of Public and
Private Agencies 220
Article 1.1. Unavailability of Verifying
Documents 221
Article 2. Content of Case Record 221
Article 3. Procedures for Post- Adoption
Services 222
Article 4. Private Adoption Agency
Reimbursement Program 225
Subchapter 4. Procedures for
Independent Adoptions 226
Article 1 . Agency Responsibility 226
Article 2. Placement for Independent
Adoption 229
Article 3. Prerequisites to Consent 232
Article 3.1. Freeing a Child for
Adoption 238
Article 4. Accepting Consent 239
Article 5. Finahzation of Adoption 240
Article 6. Procedures in Denials and
Commitments 241
Subchapters. Procedures for Agency
Adoptions 242
Article 1 . Assessment of the Child 242
Article 2. Freeing a Child for
Adoption 243
Article 3. Services for the Birth
Parents 244
Article 4. Prerequisites to Accepting a
Relinquishment 248
Article 5. Accepting the
Relinquishment 249
Article 6. Accepting the Statement of
Understanding 252
Article 7. Revocation of
Relinquishment 260.2
Article 8. Filing of Relinquishment 260.4
Article 9. Rescission of
Relinquishment 260.4
Article 10. Application to Adopt 260.6
Article 11. Assessment of the Applicant 260.8
Article 12. Adoptive Placement 260.12
Article 13. Completing the Adoption 260.16
Article 14. Grievance Review 260.18
Subchapter 6. Procedures for
Intercountry Adoptions 260.20
CODE OF REGULATIONS Title 22
Page
Article 1. General and Administrative
Requirements 260.20
Article 2. Application for the
Placement of a Child for
Adoption 260.21
Article 3. Assessment of the Applicant .... 260.21
Article 4. Assessment of the Child 260.24
Article 5. Background Information on
the Birth Parents 260.25
Article 6. Placement 260.25
Article 7. Supervision of Adoptive
Placement 260.26
Article 8. Intercountry Adoption Court
Report 260.27
Subchapter 7. Adoption Assistance
Program/ Aid for the
Adoption of Children
(AAP/AAC) 260.28
Article 1. AAP Case Initiation 260.28
Article 2. AAP Eligibility
Requirements 260.29
Article 3. AAP Payments 260.30
Article 4. Adoption Assistance Program
Agreement 260.32
Article 5. AAP Payment Authorization 260.33
Article 6. AAP Reassessment 260.33
Article 7. AAP Overpayments 260.34
Article 8. Notice of Action 260.35
Article 9. Continuation of Aid for the
Adoption of Children (AAC) .... 260.35
Article 10. Documentation of AAP
Ehgibility 260.35
Article 1 1 . Reimbursement for
Nonrecurring Adoption
Expenses 260.36
Subchapter 8. Adoption of Children with
Indian Heritage 260.36(a)
Article 1 . Additional Agency
Requirements for Adoption
of Children with Indian
Heritage 260.36(a)
Article 2. Certification of Degree of
Indian Blood (CDIB), Tribal
Membership Eligibility, and/
or Tribal Enrollment 260.36(a)
Article 3. Background Information 260.37
Article 4. Information to Parents of a
Child with Indian Heritage
Regarding Provisions of the
ICWA 260.37
Page iv
(7-18-2008)
Title 22
Social Security
Page
Freeing the Indian Child for Article 1.
Adoption 260.38 Article 2.
Information Transmitted to Article 3
Applicants in Agency
Adoptions 260.39
Article 4.
Placement and Supervision in
an Agency Adoption 260.39 Article 5.
Information Transmitted to
r, , „• Article 6.
Petitioners in an
Independent Adoption 260.39
Article V
Information Transmitted to
the Adoptee 260.40 Article 8.
Interstate Compact on the Chapter 5.
Placement of Children
(ICPC) 260.40 A • , 1
^ ' Article I.
Definitions and Conditions 260.40 . ■ i ^
Article 2.
Relinquishment Adoptions 260.40 a t' 1 ^
Independent Adoptions 260.41
Minimum Standards for Facilities Chapter 6.
for Children 260.43
Day Nurseries 260.43
^. c J 1 r Article 1.
Minimum Standards for
Residential Care Homes for Article 2.
Adults 260.43
^ . ^ * Article 3.
Continuing Care Agreements 260.43
Article 4.
Preventive Medical Services 260.43
California Health Services
Corps 260.43 Article 6.
Definitions 260.43 Article 7.
Eligibility 260.44 Article 8.
Application 261 Article 9.
Personnel 261
Charges and Reimbursements 262 * _■ i i r*
^ Article 10.
Recipient Rights 263 ^^.^j^ ^ ^
Rural Health Services Article 12.
Development Projects 263
Chapter 8.
Definitions 263
Applicants 264
Types of Assistance 264 Article 1 .
Application for Financial Article 2.
Assistance 264 Article 3.
Charges and Reimbursements 265 Article 4
Recipient Rights 265 Article 5.
Victims of Sexual Assault 266 Chanter 9
Sickle Cell Screening Program 266 Article 1 .
Title Table of Contents
Page
Definitions 266
Scope of the Regulations 266
Approval of a Sickle Cell
Screening Program 266
Services 266
Sickle Cell Screening
Laboratory Services 266
Certification of Sickle Cell
Counselors 266
Participant Rights 267
Community Relationship 267
Assistance to Primary Care
Clinics 267
Definitions 267
Eligibility for Grant 268
Administration of the Grants
Program 269
California Special Supplemental
Food Program for Women, Infants
and Children 269
Definitions 269
Certification of
Participants 272
Nondiscrimination 275
Fair Hearing Procedures for
Participants 276
Supplemental Foods 276
Nutrition Education 276.1
Food Delivery System 276.1
Selection of Local Agencies 288.3
Administrative Appeal of
Departmental Decisions
Affecting Local Agencies 289
Investigations 290
Penalties 290
Records and Reports 290
Human Immunodeficiency Virus
(HIV) Testing of Inmates in
Correctional Facilities 291
Definitions 291
Procedures 292
Appeals Process 295
Testing Procedures 298.1
Counseling 298.2
Tuberculosis Examination 298.3
Application 298.3
Article 5.
Article 6.
Article 7.
Article 8.
Article 9.
Subchapter 9
Article 1.
Article 2.
Article 3.
Chapter 4.
Subchapter 2,
Chapter 5.
Chapter 6.
Subdivision 6.
Chapter 1.
Article 1.
Article 2.
Article 3.
Article 4.
Article 5.
Article 6.
Chapter 2.
Article 1.
Article 2.
Article 3.
Article 4.
Article 5.
Article 6.
Chapter 3.
Chapter 4.
Page V
(7-18-2008)
Title Table of Contents BARCLAYS CALIFORNIA
Page
Article 2. Definitions 298.3
Article 3. Tuberculosis Examination 298.3
Article 4. Admission to School 298.3
Article 5. Records 298.4
Article 6. Reporting 299
Article 7. Exclusion from School 299
Subdivision 7. California Children's Services 299
Chapter 1. Definitions 299
Chapter 2. Administration 302
Article 1. General Provisions 302
Article 5. Records and Reports 302.1
Chapter 3. Application Process 302.1
Article 1. General Provisions 302.1
Chapter 4. Medical Eligibility 302.2
Article 1. General Provisions 302.2
Chapter 5. Residential Eligibility 302.7
Article 1. General Provisions 302.7
Chapter 6. Financial Eligibility 302.8
Article 2. Other Provisions 302.8
Article 3. CCS Legal Agreement 302.8
Article 4. Annual Enrollment Fee 302.9
Article 5. Annual EnrollmentFee
Collection 302.9
Chapter 7. Program Benefits 302.9
Article 3. Diagnostic Services 302.9
Article 4. Treatment Services 302.10
Article 6. Authorization for Services 302.10
Chapter 9. Professional Medical Care
Providers 302.10
Article 1. General Provisions 302.10
Article 3. Physicians 302.10
Article 4. Other Health Care
Professionals 302.11
Chapter 10. Hospital Providers 302. ii
Article 1. General Provisions 302.11
Article 4. Special Hospital 303
Chapter 13. Resolution of Complaints and
Appeals by CCS Chents or
Applicants 303
Article 1. Notice of Action 303
Article 2. Designated CCS Agency 304
Article 3. CCS Fair Hearing 304
CODE OF REGULATIONS Title 22
Page
Chapter 14. Other CCS Programs 304.3
Article 1. Immunization Adverse
Reaction Fund 304.3
Division 2.1 . Department of Rehabilitation 305
Chapter 1 . Programs for the Blind 305
Chapter 2. Vocational Rehabilitation
Programs 305
Division 3. Healtli Care Services 307
Subdivision 1. California Medical Assistance
Program 307
Chapter 1. Introduction 307
Chapter 2. Determination of Medi-Cal
Eligibility and Share of Cost 308
Article 1. Definitions, Abbreviations
and Program Terms 308
Article 2. Administration 317
Article 3. County of Responsibility for
Determination of Medi-Cal
Eligibihty 320
Article 4. Beneficiary Application
Process 322
Article 5. Medi-Cal Programs 336.7
Article 6. Institutional Status 341
Article 7. Alienage, Citizenship and
Residence 342
Article 8. Responsible Relatives and
Unit Determination 348
Article 9. Property 350.3
Article 10. Income 362.2
Article 1 1 . Maintenance Need 374
Article 12. Share of Cost 375
Article 13. Period of Eligibility 378
Article 14. Medi-Cal Card Use and
Issuance 379
Article 15. Other Health Care Coverage
and Medicare Buy-In
Coverage 382
Article 16. Overpayments, Fraud and
Improper Utilization 386
Article 17. Dialysis Medi-Cal Program 386.3
Article 18. State Administrative
Hearings 389
Article 19. Medi-Cal Estate Recovery 390
Chapter 2.5. Third Party Liability 390
Article 1. Definitions 390
Page vi
(7-18-2008)
Title 22
Social Security
Page
Estate Recovery 392 Article 4.
Health Care Services 392.4
Application and Enrollment 392.4
General Provisions 394.1 1 . ■ , ^
Article 5.
Provider Audit Appeals 396.3
Skilled Nursing Facility and Article 6.
Intermediate Care Facility Article 7.
Certification Appeals
Procedure 402
Definitions 403 Chapter 4.5.
Standards for Participation 424
Scope and Duration of
Benefits 436.3 Article 2.
Scope and Duration of Article 3.
Supplemental Schedule of
Benefits 466.1
Eligibility for Payment 466.1 Chapter 5.
Payment for Services and
Supplies 471 Article 2.
Hospital Inpatient Services Article 3.
Reimbursement Section 516.4(d)(7)
„ „. r^ Article 4.
Conflict of Interest 516.19
Article 5.
Early and Periodic
Article 6
Screening, Diagnosis, and
Treatment Program 517 Chapter 5.5.
Pilot and Demonstration
Projects 517
Chapter 6.
Prepaid Health Plans 517
General Provisions 517 Article 1.
T^ e- ■.■ .,^ Article 2.
Definitions 517
Article 3.
Operational Requirements 520
Article 4.
Marketing, Enrollment and
Disenrollment 528 * _• i c
Article 5.
Applications, Contracts and Article 6
Public Hearings 530
Chapter 7.
Conflict of Interest 532
Emergency Services Claims Article 1.
^''P^''' '''- Article!
Two-Plan Model Managed Care
Program 538
Article 3.
General Provisions 538
Definitions 538 „, „
Chapter 8.
Maximum Enrollment Levels 538.2
Title Table of Contents
Page
Prepaid Health Plan and
Primary Care Case
Management Plan Enrollment
Growth During the
Transition Period 538.2
Two-Plan Model
Requirements 538.2(a)
Operational Requirements 538.2(c)
Marketing, Enrollment,
Assignment, and
Disenrollment 538.2(j)
Geographic Managed Care
Program 538.2(r)
General Provisions 538.2(r)
Operational Requirements 538.3
Marketing, Enrollment,
Assignment, and
Disenrollment 538.6
Adult Day Health Care 538.10
General Provisions 538.10
Definitions 538.10
Eligibility, Participation
and Discharge 539
Services and Standards 541
Administration 546
Payment of Services 551
Indians and Indian Health
Service Facilities in Medi-Cal
Managed Care Programs 552
Primary Care Case Management
Plans 552.3
General Provisions 552.3
Definitions 552.4
Operational Requirements 556
Marketing, Enrollment and
Disenrollment 565
Apphcation and Proposal 568.1
Conflict of Interest 568.3
Construction/Renovation
Reimbursement Program 568.4
Definitions 568.4
Eligibility for Construction/
Renovation Reimbursement
Program 570
Standards for Supplemental
Reimbursement 570
California Partnership for Long-
Term Care 571
Article 2.
Chapter 3.
Article 1.
Article 1.3.
Article 1.5.
Article 1.6.
Article 2.
Article 3.
Article 4.
Article 5.
Article 6.
Article 7.
Article 7.5
Article 8.
Article 10.
Chapter 3.5.
Chapter 4.
Article I.
Article 2.
Article 3.
Article 4.
Article 5.
Article 6.
Article 7.
Chapter 4.1.
Article 1.
Article 2.
Article 3.
Page vii
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Title Table of Contents BARCLAYS CALIFORNIA
Page
Article 1 . Definitions 571
Article 2. Conditions of Issuer
Participation 578
Article 3. Benefits and Provisions for
Partnership Policies and
Certificates 584
Article 4. Premium Provisions 589
Article 5. Care Management Provider
Agency Standards 590
Article 6. Issuer Reporting
Requirements and Audit
Information 592
Chapter 11. Drug Formulary and Medical
Supplies Listing 596
Article 1 . Medical Supplies and Medi-
Cal Drug Formulary 596
Division 4. Environmental Health 599
Chapter 1 . Introduction 599
Article 1. Definitions 599
Chapter 2. Regulations for the
Implementation of the
California Environmental
Quality Act 599
Article 1. General Requirements and
Categorical Exemptions 599
Chapter 3. Water Recychng Criteria 600
Article 1. Definitions 600
Article 2. Sources of Recycled Water 602.1
Article 3. Uses of Recycled Water 602.1
Article 4. Use Area Requirements 602.2
Article 5. Dual Plumbed Recycled Water
Systems 602.4
Article 5.1. Groundwater Recharge 602.4
Article 5.5. Other Methods of Treatment 602.5
Article 6. Sampling and Analysis 602.5
Article 7. Engineering Report and
Operational Requirements 602.5
Article 8. General Requirements of
Design 603
Article 9. Alternative Reliability
Requirements for Uses
Permitting Primary
Effluent 603
CODE OF REGULATIONS Title 22
Page
Article 10. Alternative Reliability
Requirements for Uses
Requiring Oxidized,
Disinfected Wastewater or
Oxidized, Coagulated,
Clarified, Filtered,
Disinfected Wastewater 603
Article 11. Other Methods of Treatment 604
Chapter 4. Water Treatment Devices 604
Article 1 . Definitions 604
Article 2. Certification Requirements 605
Article 3. Application Requirements 605
Article 4. Testing and Testing
Protocols 606
Article 5. Product Labeling and Data
Sheet Requirements 609
Article 6. Fees 609
Chapter 12. Safe Drinking Water Project
Funding 609
Article 1. Definitions 609
Article 2. Financing Criteria 610.2
Article 3. Disadvantaged Communities 610.4
Article 4. Application Process 610.4
Article 5. Information to Be Submitted
Prior to Execution of the
Funding Agreement 610.6
Article 6. Design and Construction 610.6
Article 7. Claims and Loan Repayments 610.6
Article 8. Consohdation Projects 610.6(a)
Chapter 13. Operator Certification 610.6(a)
Article 1. Definitions 610.6(a)
Article 2. Operator Certification
Grades 610.7
Article 3. Operator Examination
Criteria and AppUcations 610.8
Article 4. Operator Certification
Criteria and Applications 610.9
Article 5. Certification Renewals,
Delinquent Renewals and
Fees 610.12
Chapter 14. Water Permits 610.13
Article 1. Applications 610.13
Article 3. State Small Water Systems 610.14
Article 4. Local Primacy Delegation 61 1
Chapter 15. Domestic Water Quality and
Monitoring Regulations 615
Article 1. Definitions 615
Page viii
(7-18-2008)
Title 22
Social Security
Page
General Requirements 616.4 Article 4.
Primary Standards —
Bacteriological Quality 616.7
Article 5
Primary Standards — Inorganic
Chemicals 616.10 Article 6.
Trihalomethanes 616.10(c) Article 7.
Radioactivity 616.10(c) Article 8.
Primary Standards — Organic
Chemicals 616.12 Chapter ] 7.
Best Available Technologies Article 1.
(BAT) 616.15
Treatment Techniques 616.17 Article 2.
Secondary Drinking Water
Standards 616.18
Special Monitoring . . . ^
J^ . , ,- * Article 3.
Requirements tor
Unregulated Chemicals 616.20 Article 4.
Notification of Water Article 5.
Consumers and the Article 6.
Department 616.21 . . , ^
^ Article 7.
Records, Reporting and
Recordkeeping 616.29 Article 8.
Consumer Confidence Report . . . 616.30
Chapter 17.5.
Disinfectant Residuals, Article 1
Disinfection Byproducts, and
Disinfection Byproduct
Precursors 616.34 Article 2.
General Requirements and
T-N c- •^- ^1^ -,. Article 3.
Defmitions 616.34
Maximum Contaminant Levels a • i /i
for Disinfection Byproducts
and Maximum Residual
Disinfectant Levels 616.34 Article 5.
Monitoring Requirements 616.39 Article 6.
CompUance Requirements 616.41
Treatment Technique for Article 7
Control of Disinfection
Byproduct Precursors
(DBPP) 616.42
Article 8.
Reporting and Recordkeeping
Requirements 616.44
California Waterworks Article 9.
Standards 616.45
Definitions 616.45 Chapter 18.
Waivers and Alternatives 616.46 Article 1.
Permit Requirements 616.46 Chant r 1 9
Water Sources 619
Title Table of Contents
Page
Materials and Installation
of Water Mains and
Appurtenances 620
Disinfection Requirements 621
Distribution Reservoirs 622
Additives 622
Distribution System
Operation 622. l
Surface Water Treatment 622.3
General Requirements and
Definitions 622.3
Treatment Requirements,
Watershed Protection
Requirements, and
Performance Standards 622.5
Monitoring Requirements 622.6(b)
Design Standards 622.6(b)(3)
Operation 622.6(b)(3)
Reporting 622.6(b)(4)
Watershed Sanitary
Surveys 622.6(b)(5)
Public Notification 622.6(b)(5)
Lead and Copper 622.6(b)(6)
General Requirements and
Definitions 622.6(b)(6)
Requirements According to
System Size 622.6(e)
Monitoring for Lead and
Copper 622.6(0
Water Quality Parameter
(WQP) Monitoring 622.6(i)
Corrosion Control 622.6(1)
Source Water Requirements
for Action Level
Exceedances 622.6(k)
Public Education Program for
Lead Action Level
Exceedances 622.6(1)
Lead Service Line
Requirements for Action
Level Exceedances 622.6(o)
Reporting and
Recordkeeping 622.6(p)
Drinking Water Additives 622.6(q)
Requirements 622.6(q)
Certification of Environmental
Laboratories 622.6(q)
Article 2.
Ardcle 3.
Article 4.
Article 4.5
Article 5.
Article 5.5
Article 12.
Article 14.
Article 16.
Article 17.
Article 18.
Article 19.
Article 20.
Chapter 15.5.
Article 1.
Article 2.
Article 3.
Article 4.
Article 5.
Article 6.
Chapter 16.
Article 1.
Article 1.5.
Article 2.
Article 3.
Page ix
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Title Table of Contents BARCLAYS CALIFORNIA
Page
Article 1. Definitions 622.6(q)
Article 2. Certification and Amendment
Process 622.7
Article 3. Application Process 622.8
Article 4. Site Visits 622.8
Article 5. Performance Evaluation
Testing Process 622.9
Article 6. Required Test Methods 622.9
Article 7. Laboratory and Equipment 622.10
Article 8. Quality Assurance
Documents 622.10
Article 9. Laboratory Personnel 622.10
Article 10. Notification and Reporting 622.1 1
Article IL Reciprocity Agreements 622.12
Article 12. Subgroups for Fields of
Testing 622.12
Article 13. Trade Secrets 622.14
Article 14. Sale or Transfer of
Ownership of a Laboratory 622.14
Article 16. National Environmental
Laboratory Accreditation
Program (NELAP) 622.15
Chapter 20. Public Swimming Pools 622.15
Article 1. Definitions and Scope 622.15
Article 2. Plans, Construction and
Inspection 623
Article 3. Maintenance and Operation 623
Chapter 21 . Minimum Standards for Permitting
Medical Waste Facilities 625
Article 1. Definitions and Scope 625
Article 2. General Provisions 626
Article 3. Medical Waste Treatment
Facility Permits 626.1
Article 4. Fees 626.4
Chapter 22. Safety Regulations for
Playgrounds 626.4
Article 1 . Definitions 626.4
Article 2. General Standards 626.5
Article 3. Certified Playground Safety
Inspector Requirements 626.6
Article 4. Provisions for Child Care
Centers and Facilities
Operated for the
Developmentally Disabled 626.6
CODE OF REGULATIONS Title 22
Page
Division 4.5. Environmental Health Standards
for the Management of
Hazardous Waste 627
Chapter 10. Hazardous Waste Management
System: General 627
Article 1. General 627
Article 1.5. Conflict of Interest Code 635
Article 2. Definitions 637
Article 3. Variances 657
Chapter 11. Identification and Listing of
Hazardous Waste 660
Article 1. General 660
Article 2. Criteria for Identifying the
Characteristics of
Hazardous Waste 668.3
Article 3. Characteristics of Hazardous
Waste 668.3
Article 4. Lists of Rcra Hazardous
Wastes 668.6
Article 4. 1 . Additional Lists of
Hazardous Wastes 681
Articles. Categories of Hazardous
Waste 681
Chapter 12. Standards Applicable to
Generators of Hazardous Waste 692
Article 1. Applicability 692
Article 2. The Manifest 693
Article 3. Pre-Transport Requirements 694
Article 4. Recordkeeping and Reporting 698
Article 5. Exports of Hazardous Waste 699
Article 6. Imports of Hazardous Waste 702
Article 7. Farmers 703
Article 8. Transfrontier Shipments of
Hazardous Waste for
Recovery Within the OECD 703
Chapter 13. Standards Applicable to
Transporters of Hazardous
Waste 714
Article 1. General 714
Article 2. Compliance with the Manifest
System and Recordkeeping 715
Article 3. Hazardous Waste Discharges 718
Article 4. Regulatory Exemptions for
Certain Transportation
Operations 718
Article 5. Railroad Accident Prevention
and Immediate Deployment
(RAPID) Force 720.1
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Page
Standards for Owners and Chapter 15.
Operators of Hazardous Waste
Transfer, Treatment, Storage,
and Disposal Facilities 720.1
General 720.1
Article 1 .
General Facility Standards 720.3
Article 2.
Preparedness and Prevention 720.7 a f' 1 l
Contingency Plan and
Emergency Procedures 720.7 Article 4
Manifest System,
Recordkeeping, and Article 5.
Reporting 720.9
Water Quality Monitoring and
Response Programs for Article 6.
Permitted Facilities 720.14
Closure and Post-Closure 728
Article 7.
Financial Requirements 734 . . , ^
Article 8.
Use and Management of Article 9
Containers 750.18
Tank Systems 752 Article 10.
Surface Impoundments 755 Article 11.
Waste Piles 758.3 Article 12.
Land Treatment 758.6 Article 13.
T jf„ Article 14.
Landfills 758.10
Article 15.
Residuals Repositories 758.12(c) . ,
Article 16.
Incinerators 758.12(d) Article 17.
Corrective Action for Waste
Management Units 758.14 Article 1 7.5.
Drip Pads 758.16(d) Article 18.
Miscellaneous Units 758.18
Environmental Monitoring and Article 27
Response Programs for Air,
Soil, and Soil-Pore Gas for
Permitted Facilities 758.18(a) Article 28.
Corrective Action for Solid * _• i -,o ^
TT • Article 28.5.
Waste Management Units 758.18(d)
Air Emission Standards for
Process Vents 758.45
Air Emission Standards for Article 29.
Equipment Leaks 758.52 ^^^^^^^ ^^
Air Emission Standards for
Tanks, Surface Article I.
Impoundments, and \ ■ \ i
Containers 758.54(d)
Containment Buildings 758.54(s)
Title Table of Contents
Page
Interim Status Standards for
Owners and Operators of
Hazardous Waste Transfer,
Treatment, Storage, and
Disposal Facilities 758.54(u)
General 758.54(u)
General Facility Standards 758.54(w)
Preparedness and
Prevention 758.54(z)(i)
Contingency Plan and
Emergency Procedures 758.54(z)(l)
Manifest System,
Recordkeeping, and
Reporting 758.54(z)(3)
Water Quality Monitoring and
Response Programs for
Interim Status Facilities 758.54(z)(8)
Closure and Post-Closure 758.62
Financial Requirements 758.69
Use and Management of
Containers 758.81
Tank Systems 758.81
Surface Impoundments 758.90
Waste Piles 758.93
Land Treatment 758.95
Landfills 758.98
Incinerators 758.103
Thermal Treatment 758.104
Chemical, Physical, and
Biological Treatment 758.105
Drip Pads 758.106
Environmental Monitoring of
Air and Soil-Pore Gas for
Interim Status Facilities 758.108
Air Emission Standards for
Process Vents 758.112(a)
Air Emissions Standards for
Equipment Leaks 758.112(g)
Air Emission Standards for
Tanks, Surface
Impoundments, and
Containers 758.112(0(1)
Containment Buildings .... 758.1 I2(i)(23)
Recyclable Materials (Recyclable
Hazardous Wastes) 758.il2(n)
General 758.ll2(n)
Generator, Transporter and
Facility Operator
Requirements 758.ii2(n)
Chapter 14.
Article 1.
Article 2.
Article 3.
Article 4.
Article 5.
Article 6.
Article 7.
Article 8.
Article 9.
Article 10.
Article 11.
Article 12.
Article 13.
Article 14.
Article 14.5
Article 15.
Article 15.5
Article 15.7
Article 16.
Article 17.
Article 19.
Article 27.
Article 28.
Article 28.5.
Article 29.
Page xi
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Page
Article 3. Requirements for Recyclable
Materials That Are Placed
on the Land (Used in a
Manner That Constitutes
Disposal) 758.112(0)
Article 4. Hazardous Wastes and Certain
Used Oils Regulated as
Hazardous Waste Fuels 758.1 I2(p)
Article 5. [Reserved] 758.1 I2(q)
Article 6. Requirements for Management
of Used Oil 758.1 12(q)
Article 7. Requirements for Management
of Spent Lead-Acid Storage
Batteries 758.1 I2(r)
Article 8. Hazardous Waste Burned in
Boilers and Industrial
Furnaces 758.1 I2(s)
Article 8.5. Requirements for
Management of Recyclable
Materials Used in
Agriculture 758.ll2(z)(i4)
Article 9. Requirements for
Management of Waste
Elemental Mercury 758.1 I2(z)(i5)
Article 10. Requirements for
Management of Certain
Oily Wastes 758.1 I2(z)(i5)
Chapter 17. Military Munitions 758.i22(z)(2)
Chapter 18. Land Disposal
Restrictions 758.l22(z)(2)
Article 1. General 758.l22(z)(2)
Article 2. Schedule for Land Disposal
Prohibition and
Establishment of Treatment
Standards 758.123
Article 3. Prohibitions on Land
Disposal 758.128
Article 4. Treatment Standards 758.133
Articles. Prohibitions on Storage 758.190
Article 10. Land Disposal Prohibitions —
Non-RCRA Wastes 758.191
Article 1 1 . Treatment Standards — Non-
RCRA Waste Categories 758.191
Article 12. Incineration Requirements of
Certain Hazardous Waste 758.192(b)
Chapter 19. Fees 758.262
Chapter 20. The Hazardous Waste Permit
Program 758.271
Article 1. General Information 758.271
CODE OF REGULATIONS Title 22
Page
Article 2. Permit Application 758.273
Article 3. Permit Conditions 758.287
Article 4. Permit Changes and Denials 758.289
Article 5. Expiration and Continuation
of Permits 758.294
Article 6. Special Forms of Permits 758.294
Article 6.5. Standardized Permits 758.30()(b)
Article 7. Interim Status 758.300(d)
Chapter 2 1 . Procedures for Hazardous Waste
Permit Decisions 758.304(b)
Article 1. General Program
Requirements 758, 304(b)
Article 2. Specific Procedures
Applicable to RCRA
Permits 758.304(h)
Chapter 22. Enforcement, Inspections, and
Informant Rewards 758.304(i)
Article 1. Inspection Authority,
Designation of Enforcement
Authority, and Awards 758.304(i)
Article 2. Delegation of Enforcement
Order Authority 758.305
Article 3. Assessment of Administrative
Penalties 758.306
Chapter 23. Standards for Universal Waste
Management 758.306(d)
Article 1 . General 758.306(d)
Article 2. Standards for Small Quantity
Handlers of Universal
Waste 758.306(1)(])
Article 3. Standards for Large Quantity
Handlers of Universal
Waste 758.306(0(1 1)
Article 4. Standards for Universal
Waste Transporters 758.306(l)(22)
Article 5. Standards for Destination
Facilities 758.306(l)(25)
Article 6. Import Requirements 758.306(1)(26)
Article 7. Standards for CRT Material
Handlers 758.306(1)(26)
Chapter 29. Standards for the Management
of Used Oil 758.306(1)(32)
Article 1. Definitions 758.306(1)(32)
Article 2. Applicabihty 758.306(0(33)
Article 3. Standards for Used Oil
Generators 758.306(m)
Article 4. Standards for Used Oil
Collection Centers 758.306(n)
Page xii
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Title 22
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Page
Standards for Used Oil Article 5.
Transporters and Transfer
Facilities (66279.40)
[Reserved] 738.306(n)
Standards for Used Oil
Recycling Facilities
(66279.50) [Reserved] 758.306(n)
[Reserved] 758.306(n) Chapter 45.5.
[Reserved] 738.306(n)
[Reserved] 758.306(n) Article 1.
Testing Standards and
Recordkeeping
Requirements 758.306(n)
Chapter 46.
Waste Minimization 758.315
Hazardous Waste Source
Reduction and Management
Review 758.315 Chapter 47.
Article 1.
Management of Tanks 758.325
Best Management Practices for
Perchlorate Materials 758.329
General 758.329 Article 2.
Alternative Management
Standards for Treated Wood Chapter 50.
Waste 758.330(c) Article 1.
Hazardous Waste Property and
Border Zone Property 758.330(g) Article 1.5.
Selection and Ranking Criteria Art' l 9
for Hazardous Waste Sites
Requiring Remedial Action 758.330(h)
„ , ., . , ^, , r^ ., Chapter 51.
Prohibited Chemical Toilet
Additives 758.333 Article 1 .
Requirements for Management of
Fluorescent Light Ballasts Chapter 51.5.
which Contain Polychlorinated Article 1 .
Biphenyls (PCBs) 758.335
Additional Requirements for
Management of Extremely
Hazardous Wastes 758.336 Chapter 52.
Hazardous Waste Testing
Laboratory Certification 758.336 Division 5
Requirements for Units and
Facilities Deemed to Have a
Permit by Rule 758.336
Permit By Rule 758.336 Chapter 1.
[Reserved] 758.338(1) Article 1 .
[Reserved] 758.338(1) Article 2.
[Reserved] 758.338(1) Article 3.
Title Table of Contents
Page
Requirements Applicable to
the Operation of K-12
Schools Hazardous Waste
Collection, Consolidation,
and Accumulation Facilities
(SHWCCAF) Deemed to Have
a Permit by Rule 758.338(1)
Procurement of Site or Facility
Cleanup Services 758.342
Selection Process for
Private Architectural and
Engineering Services for
Sites or Facilities 758.342
Hazardous Waste Environmental
Technology Certification
Program 758.345
Loan Programs 758.346(a)
Cleanup Loans and
Environmental Assistance to
Neighborhoods Revolving
Loan Fund 758.346(a)
Groundwater Remediation
Loan Program 758.346(h)(2)
Corrective Action 758.346(j)
Department of Toxic
Substances Control 758.346(j)
Unified Program Agency
Qualification 758.347
Corrective Action
Approach 758.348(e)
Site Remediation 758.348(e)
Private Site Management
Performance Standards 758.348(e)
Assessment of School Sites 758.355
Phase I Environmental Site
Assessments (Proposed New
and Expanding School
Sites) 758.355
Voluntary Registration of
Environmental Assessors 758.358(a)
Licensing and Certification of
Health Facilities, Home Health
Agencies, Clinics, and Referral
Agencies 759
General Acute Care Hospitals 759
Definitions 759
License 763
Basic Services 767
•
Article 5.
Article 6.
Article 7.
Article 8.
Article 9.
Article 10.
Chapter 31.
Article 1 .
Chapter 32.
Chapter 33.
Article 1.
Chapter 34.
Chapter 39.
Chapter 40.
Chapter 41.
Chapter 42.
Chapter 43.
Chapter 44.
Chapter 45.
Article 1.
Article 2.
Article 3.
Article 4.
Page xiii
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Title Table of Contents BARCLAYS CALIFORNIA
Page
Article 4. Supplemental Service
Approval 774
Article 5. Special Permit 775
Article 6. Supplemental Services 776
Article 7. Administration 798
Article 8. Physical Plant 808
Article 9. Regulations Specific to
Small and Rural Hospitals 814
Chapter 2. Acute Psychiatric Hospital 815
Article 1. Definitions 815
Article 2. License 817
Article 3. Basic Services 821
Article 4. Supplemental Service
Approval 826
Article 5. Supplemental Services 827
Article 6. Administration 827
Article 7. Physical Plant 833
Chapter 2.5. Certified Nurse Assistant
Program 837
Article 1 . Definitions 837
Article 2. Administration 840
Article 3. Program Components 841
Article 4. Continuing Education and In-
Service Training 845
Article 5. Adverse Actions and
Corrective Remedies 847
Chapter 3. Skilled Nursing Facilities 848
Article 1 . Definitions 848
Article 2. License 848.4
Article 3. Required Services 848.5
Article 4. Optional Services 853
Article 5. Administration 859
Article 6. Physical Plant 867
Article 7. Violations and Civil
Penalties 871
Chapter 3.5. Receivership Management of Long-
Term Care Facilities 873
Chapter 4. Intermediate Care Facilities 873
Article ] . Definitions 873
Article 2. License 876.1
Article 3. Services 881
Article 4. Administration 901
Article 5. Physical Plant 906
CODE OF REGULATIONS Title 22
Page
Article 6. Violations and Civil
Penalties 91 1
Chapter 4.5. Intermediate Care Facility/
Developmentally Disabled-
Nursing 914
Chapter 5. Referral Services 914
Article 1. Definitions 914
Article 2. License 915
Article 3. Administration 950
Article 4. Services 950
Article 5. Personnel Requirements 951
Article 6. General Provisions 952
Chapter 6. Home Health Agencies 952
Article L Definitions 952
Article 2. License 956
Article 3. Services 959
Article 4. Administration 962.2
Article 5. Qualifications for Home
Health Aide Certification 962.9
Chapter 7. Primary Care Clinics 962.10
Article 1. Definitions 962.10
Article 2. License 963
Article 3. Basic Services 964
Article 4. Drug Distribution 965
Article 5. Abortion Service 966
Article 6. Administration 966
Article 7. Physical Plant 968
Article 8. Appeals Procedure 969
Article 9. Birth Services 970
Chapter 7.L Specialty Clinics 971
Article 6. Hemodialyzer Reuse 971
Chapter 7.2. Psychology Clinics 977
Article L Definitions 977
Article 2. License 977
Article 3. Basic Services 977
Article 4. Administration 978
Article 5. Physical Plant 980
Chapter 8. Intermediate Care Facilities for
the Developmentally Disabled 981
Article 1. Definitions 981
Article 2. License 985
Article 3. Services 990
Article 4. Administration 1006
Article 5. Physical Plant 1016
Page xiv
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Title 22
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Violations and Civil Division 6.
Penalties 1020
Intermediate Care Facilities/ Chapter 1 .
Developmentally Disabled — Article 1 .
Habilitative 1023 Article 2
Definitions 1023 Article 3.
License 1025 Article 4.
Services 1026 Article 6.
Administration 1036 Article 7.
nu • 1 ni * ,^.^ Article 8.
Physical Plant 1042
Violations and Civil
Penalties 1044 Chapter 2.
Psychiatric Health Facilities 1044 Subchapter 1
Definitions 1044 Article 1 .
Licensing and Inspection 1047
Article 2.
Services 1049
Article 3.
Administration 1054
Article 4.
Physical Plant 1058.2 . . . ^
Adult Day Health Centers 1058.2
Article 6.
Definitions 1058.2
Article 7.
License 1061
Chapter 3.
Services 1063
Article 1.
Administration 1068
Article 2.
Physical Plant 1072 . • . ^
Violations 1073 Article 4
Chemical Dependency Recovery
Hospital Licensing Regulations ..... 1074 Articles.
T-» *• •^- .^-,. Article 6.
Definitions 1074
Article 7.
Licensing and Inspection 1075
Article 8.
Basic Services 1077
^ . , r. • Chapter 3.5.
Optional Services 1080
Article 1.
Administration 1080
Article 2.
Physical Plant 1085 . . . ^
Correctional Treatment Centers 1085 Article 4.
Definitions 1085
Article 5.
Licensing and Inspection 1086.3
Article 6.
Required Services 1086.4 . . , _
Optional Services 1086.13
Chapter 4.
Administration 1086.20 * .- i i
Article 1 .
Physical Plant and Safety 1086.27
Title Table of Contents
Page
Licensing of Community Care
Facilities i087
General Licensing Requirements .... 1087
General Definitions 1087
License 1091
Application Procedures 1092
Administrative Actions 1103
Continuing Requirements 1 107
Physical Environment 1119
Incidental Medical
Services 1120
Social Rehabilitation
Facilities 1120.4
Basic Requirements 1 120.4
General Requirements and
Definitions 1120.4
Licensing 1 120.5
Applications Procedures 1 120.5
Administrative Actions 1 120.6
Enforcement Provisions
(Reserved) 1120.6
Continuing Requirements 1 120.6
Physical Environment 1120.11
Adult Day Programs 1120.12
General Requirements 1120.12
Licensing 1 120.16
Application Procedures 1120.17
Administrative Actions and
Inspection Authority 1 120.25
Enforcement Provisions 1120.26
Continuing Requirements 1120.28
Physical Environment 1120.38
Incidental Medical Services 1120.40
Adult Day Support Center 1120.44
General Requirements 1120.44
Licensing (Reserved) 1120.44
Application Procedures 1120.44
Administrative Actions
(Reserved) 1 120.44
Civil Penalties (Reserved) 1120.44
Continuing Requirements 1120.44
Physical Environment 1120.46
Small Family Homes 1120.46
General Requirements and
Definitions 1 120.46
Article 6.
Chapter 8.5.
Article 1.
Article 2.
Article 3.
Article 4.
Article 5.
Article 6.
Chapter 9.
Article 1.
Article 2.
Article 3.
Article 4.
Article 5.
Chapter 10.
Article 1.
Article 2.
Article 3.
Article 4.
Article 5.
Article 6.
Chapter 11.
Article 1.
Article 2.
Article 3.
Article 4.
Article 5.
Article 6.
Chapter 12.
Article 1.
Article 2.
Article 3.
Article 4.
Article 5.
Article 6.
Page XV
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Article 2. Licensing 1120.47
Article 3. Application Procedures 1 121
Article 4. Administrative Actions
(Reserved) 1121
Article 5. Enforcement Provisions 1121
Article 6. Continuing Requirements 1121
Article 7. Physical Environment 1 1 26. i
Chapter 5. Group Homes 1 126.2
Article L General Requirements and
Definitions 1126.2
Article 2. Licensing 1129
Article 3. Application Procedures 1129
Article 4. Administrative Actions 1131
Article 5. Enforcement Provisions 1131
Article 6. Continuing Requirements 1132
Article 7. Physical Environment 1134.13
Article 9. Administrator Certification
Training Programs 1134.14
Subchapter 1 . Community Treatment
Facilities 1134.14(c)
Article L General Requirements and
Definitions 1134.14(c)
Article 2. Licensing (Reserved) 1134.14(d)
Article 3. Application Procedures 1134.14(d)
Article 4. Administrative Actions 1134.14(d)
Article 5. Enforcement Provisions 1134.14(e)
Article 6. Continuing Requirements 1134.14(e)
Article 7. Physical Environment 1134.14(1)
Subchapter 2. Care for Children Under
the Age of Six Years Il34.i4(j)
Article L General Requirements and
Definitions Ii34.i4(j)
Article 3. Application Procedures Ii34.i4(k)
Article 6. Continuing Requirements — Il34.i4(k)
Article 7. Physical Environment Il34.i4(r)
Subchapter 3. Emergency Intervention in
Group Homes 1134.i4(s)
Article L General Requirements Il34.i4(s)
Article 3. Application Procedures Il34.i4(t)
Article 6. Continuing Requirements 1134.17
Subchapter 4. Transitional Shelter Care
Facilities 1134.18
Article L General Requirements 1134.18
Article 2. License 1134.19
Article 3. Application Procedures 1134.19
CODE OF REGULATIONS Title 22
Page
Chapter 6. Adult Residential Facilities 1 134.20
Article L General Requirements and
Definitions 1 1 34.20
Article 2. Licensing 11 34.22
Article 3. Application Procedures 1134.22
Article 4. Administrative Actions
(Reserved) 1 134.22
Article 5. Enforcement Provisions 1134.22
Article 6. Continuing Requirements 1134.22
Article 7. Physical Environment 1 140.2(b)
Article 9. Administrator Certification
Training Programs 1140.4
Chapter 7. Transitional Housing Placement
Program 1140.7
Article L General Requirements 1140.7
Article 2. License Required 1 140.8
Article 3. Application Procedures 1140.8
Article 4. Administrative Actions 1 140.1 1
Article 5. Enforcement Provisions
(Reserved) 1140.12
Article 6. Continuing Requirements 1140.12
Article 7. Physical Environment 1 140.18(a)
Chapter 7.3. Crisis Nurseries 1140.19
Article L General Requirements and
Definitions 1 140.19
Article 2. License Required 1140.22
Article 3. Application Procedures 1140.25
Article 4. Administrative Actions 1140.36
Article 5. Enforcement Provisions 1140.37
Article 6. Continuing Requirements 1140.40
Article 7. Physical Environment 1140.56
Chapter 7.5. Foster Family Homes 1140.59
Article L General Requirements and
Definitions 1140.59
Article 2. License 1140.59
Article 3. Application Procedures 1141
Article 4. Administrative Actions 1144
Article 6. Continuing Requirements 1146
Article 7. Physical Environment 1149
Chapter 8. Residential Care Facilities for
the Elderly (RCFE) 1149
Article 1. Definitions and Forms 1149
Article 2. License 1154
Article 3. Application Procedures 1158
Article 4. Operating Requirements 1160
Page xvi
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Page
Physicial Environment and Article 1.
Accommodations 1 167
Background Check 1170 Article 2.
Personnel 1174 Article 3.
Resident Assessments, Article 4.
Fundamental Services and Article 5.
Rights 1178
Chapter 10.
Resident Records 1 1 80.2(b)
Food Services 11 80.2(c)
Health-Related Services and -.. . .
_ ,. . Division 7.
Conditions ll80.2(i)
Dementia l I80.2(s)
Chapter 1.
Enforcement l]80.2(y)
Administrative Actions — Article!.
General ii80.2(z)(2) . ■. ^
Article 2.
Administrator Certification * ^- i -»
rr. • • r, ,7 , Article 3.
Training Programs — Vendor
Information 1180.2(z)(2)
Article 4.
Residential Care Facilities for Article 5
the Chronically 111 I180.2(z)(6)
Article 6.
License 1180.2(z)(6)
Definitions ll80.2(z)(6)
Application Procedures 1180.4 Article 7.
Administrative Actions 1180.15 Articles.
Enforcement Provisions 1180.16 Article 9.
Continuing Requirements 1180.19
„, . 1 r^ Article 1 1 .
Physical Environment 1180.25
Article 12.
Medical and Health Related
Care 1180.27
Foster Family Agencies 1180.37 Chanter 2
General Requirements and
Definitions 1180.37 Article 1.
License 1180.38 Article 2.
Apphcation Procedures 1180.38
Certification and Use of Chapter 3.
Homes 1182
Administrative Actions 1182.1 Article!.
Complaints 1182.2 Article 2.
Continuing Requirements 1182.2 Article 3.
Physical Environment 11 82.8(a) Article 4.
Article 5.
Adoption Agencies 1182.9
License 1182.9 Article 6.
Administration 1182.10 ^. , .
Chapter 4.
Foster Family Homes 1 1 82. 14 Article ! .
Title Table of Contents
Page
General Requirements,
Definitions, and Forms 1182.14
Administrative 1185
License/Approval Standards 1 186.8
Placement 1186.14
Special Health Care Needs 1186.16
Regulations Regarding
Supervision of Life Care
Contracts 1186.19
Health Planning and Facility
Construction 1191
Health Planning and Resources
Development 1191
Definitions 1191
Advisory Health Council 1 193
Area Health Planning
Agencies 1195
Office Functions 1195
Certificate of Need 1 196
Hearing Procedure on
Applications for a
Certificate of Need 1 198
Appeals 1199
Certificate of Exemption 1200
Terms and Conditions 1200
Development of Plans 1201
Review Criteria 1202
Procedures and Requirements
Relating to the California
Environmental Quality Act 1204
Eminent Domain Procedures for
Nonprofit Hospitals 1205
Definitions 1205
General Provisions and
Procedures 1206
Freestanding Cardiac
Catheterization Pilot Project 1208
General Provisions 1208
Monitoring 1209
Fees 1210
Operational Requirement 1210
Compliance with Other Laws
and Regulations 1210
Definitions 1211
Fire Protection Loans 1211
Definitions 1211
Article 5.
Article 6.
Article 7.
Article 8.
Article 9.
Article 10,
Article 11.
Article 12.
Article 13.
Article 14.
Article 15.
Chapter 8.5.
Article 1.
Article 2.
Article 3.
Article 4.
Article 5.
Article 6.
Article 7.
Article 8.
Chapter 8.8.
Article 1.
Article 2.
Article 3.
Article 4.
Article 5.
Article 6.
Article 7.
Article 8.
Chapter 9.
Article 1.
Article 2.
Chapter 9.5.
Page xvii
(7-18-2008)
Title Table of Contents BARCLAYS CALIFORNIA
Page
Article 2. General Provisions 121 1
Chapter 5. Health Facility Construction
Loan Insurance 1214
Article L Definitions 1214
Article 2. General Provisions 1216
Article 3. California Health Facilities
Construction Loan Insurance
Program — State Plan 1220
Article 4. Defaults 1220
Article 5. Termination of Insurance 1220
Article 6. Health Facility Construction
Loan Insurance Fund 1220
Article 7. California Health Facilities
Construction Loan Insurance
Program — Stale Plan 1220
Chapter 6. Health Workforce Pilot Project
Program 1220
Article 1. Definitions 1220
Article 2. Minimum Standards 1221
Article 3. Application Procedure 1221
Article 4. Content of Application 1222
Article 5. Application Review Process 1224
Article 6. Project Approval 1224
Article 7. Program Responsibilities 1224
Article 8. Project Completion/
Termination 1225
Chapter 7. Seismic Structural Safety
Standards 1226
Article 1. General Provisions 1226
Article 2. Definitions 1226
Article 3. Approval of Drawings and
Specifications 1226.1
Article 4. Fees 1226.2
Article 5. Approval of Construction 1226.2
Article 6. Appeals Procedures of the
Building Safety Board 1227
Article 7. General Design Requirements
(Testing and Inspection) 1227
Article 8. Masonry (Testing and
Inspection) 1227
Article 9. Wood (Testing and
Inspection) 1227
Article 10. Concrete (Testing and
Inspection) 1227
Article 11. Steel and Iron (Testing and
Inspection) 1228
CODE OF REGULATIONS Title 22
Page
Article 12. Aluminum (Testing and
Inspection) 1228
Article 13. Excavations, Foundations and
Retaining Walls (Testing
and Inspections) 1228
Article 14. Veneer (Testing and
Inspection) 1228
Article 15. Masonry or Concrete
Chimneys, Fireplaces and
Barbecues (Testing and
Inspection) 1228
Article 16. Contracts 1228
Chapter 8. Clinic Renovation (Construction)
Grant and Loan Program 1228
Article 1. Definitions 1228
Article 2. Eligibility 1229
Article 3. Types of Assistance 1229
Article 4. General Provisions 1229
Article 5. Application for Funds 1229
Article 6. Selection Process 1229
Article 7. Administration 1230
Chapter 9. Hospital Charges and Fair
Pricing Policies Reporting 1230
Article 1. Hospital Charge Description
Master Reporting 1230
Article 2. Hospital Fair Pricing
Policies Reporting 1231
Chapter 10. Health Facility Data 1232
Article 1. General 1232
Article 2. Accounting System
Requirements 1233
Article 3. Reporting Requirements 1235
Article 4. Modification, Extension, and
Appeal Processes 1236
Article 5. Collection of Special Fees 1236.2
Article 6. Public Availability of
Disclosure Materials 1237
Article 7. CABG Data Reporting
Requirements 1237
Article 8. Patient Data Reporting
Requirements 1238.7
Chapter 11. Alzheimer's Disease Institute
Demonstration Project 1251
Subchapter 1. Definitions 1251
Subchapter 2. General Requirements 1263
Article 1. Institute Administration 1263
Article 2. Patient Services Management 1267
Page xviii
(7-18-2008)
Title 22
Social Security
Page
Staff 1283 Subchapter 9.
Environmental Safety and
Health 1288 Article 1 .
Physical Plant 1289 Article 2.
Standards for All Types of Article 3.
Services 1295 Article 4.
Monitoring and Compliance 1295 Article 5.
Skilled Nursing Services 1297 Subchapter 10.
Definitions 1297 Article 1.
Designation 1297 Article 2.
Required Services 1297 Article 3.
Administration 1301 Article 4.
Intermediate Care Article 5.
Services 1301 Subchapter 1 1 .
Definitions 1301 Article 1.
Designation 1301 Article 2.
Services 1302 Article 3.
Administration 1303 Article 4.
Outpatient Care Article 5.
Definitions 1303 Article 6.
Definitions 1303 Article 7.
Designation 1304 Subchapter 12.
Basic Services 1304
^ ^. ., . Article 1.
Drug Distribution 1305
.... . Article 2.
Administration 1306
Article 3.
Day Health Care Services 1306
Definitions 1306 Article 4
Designation 1307 Subchapter 13.
Services 1307 Article 1.
Administration 1309 Article 2.
Physical Plant 131 1 Article 3.
Social Day Care Services I3il Article 4.
Definitions 1311 Chapter 12.
Administration 131 1
Patient Services 1312 Article 1 .
Designation 1313 Article 2.
Home Health Care ^^^^^'^ ^■
Services 1313 Article 4.
Definitions 1313 Article 5.
Designation 1313 Article 6.
Services 1314 Article 7.
Administration 1316 Article 8.
Qualifications for Home Chapter 13.
Health Aide Certification 1317
Title Table of Contents
Page
In-Home Supportive
Services 1318
Definition 1318
Designation 1318
Services 1318
Staff 1319
Administration 1319
Respite Care Services 1319
Definitions 1319
Training 1320
Administration 1320
Services 1320
Designation 1320
Hospice Care Services 1321
Definitions 1321
Required Services 1321
Staff 1322
Continuity of Care 1323
Other Services 1324
Administration 1325
Designation 1325
Residential Care
Services 1325
Definitions 1325
Designafion 1325
Administration and Staffing
Requirements 1325
Basic Services 1326
Referral Services 1329
DefiniUons 1329
Designation 1329
Administration 1329
Services 1330
Postsurgical Recovery Care
Demonstration Project 1330
Definitions 1330
Required Services 1335
General Requirements 1339
Administration 1341
Fees 1345
Operational Requirements 1 345
Monitoring and Compliance 1345
Physical Plant 1346.1
Mobile Cardiac Catheterization
Pilot Project 1347
•
Article 3.
Article 4.
Article 5.
Article 6.
Arncle 7.
Subchapter 3.
Article 1.
Article 2.
Article 3.
Article 4.
Subchapter 4.
Article 1.
Article 2.
Article 3.
Article 4.
Subchapter 5.
Article 1.
Article 2,
Article 3.
Article 4.
Article 5.
Subchapter 6.
Article 1.
Article 2.
Article 3.
Article 4.
Article 5.
Subchapter 7.
Article 1.
Article 2.
Article 3.
Article 4.
Subchapter 8.
Article 1.
Article 2.
Article 3.
Article 4.
Article 5.
Page xix
(7-18-2008)
Title Table of Contents BARCLAYS CALIFORNIA
Page
Article 1 . Definitions 1347
Article 2. Relationship Between Base
and Host Hospital During
Pilot Program Operation 1347
Article 3. General Provisions 1347
Article 4. Interim Program Use of
Mobile Lab When Replacing a
Hospital Based Cardiac
Catheterization Laboratory 1348
Article 5. Monitoring and Record
Keeping 1348
Article 6. Fees 1 348
Article 7. Operational Requirement 1348
Article 8. Compliance with Other Laws
and Regulations 1348
Chapter 14. Minority Health Professions
Education Foundation 1349
Article 1 . Definitions 1349
Article 2. General Provisions 1352.3
Article 3. Scholarships 1352.4
Article 4. Loan Repayment Program 1352.6
Article 5. Registered Nurse Education
Program 1352.6
Article 6. Appeals 1352.7
Article 7. Citizenship and Alien
Verification Requirements 1352.8
Chapter 15. Associate Degree Nursing
Scholarship Program 1352.15
Chapter 16. Vocational Nurse Scholarship and
Loan Repayment Program 1352.17
Article 1. General Provisions 1352.17
Article 2. Scholarship Program
Provisions 1352.18
Article 3. Loan Repayment Program
Provisions 1352.20
Chapter 17. Licensed Mental Health Service
Provider Education Program 1352.21
Division 8. Nondiscrimination in State-
Supported Programs and
Activities 1353
Chapter 1. Purpose, General Definitions and
General Provisions 1353
CODE OF REGULATIONS Title 22
Page
Article 1. Purpose and General
Provisions 1353
Article 2. General Definitions 1354
Article 3. Applicability 1354
Chapter 2. Discriminatory Practices
Relating to All Groups
Protected by Article 9.5 1355
Article 1. General Prohibitions Against
Discrimination 1355
Article 2. Mandatory and Permissive
Remedial Action 1355
Chapter 3. Discriminatory Practices
Relating to Specific Groups
Protected by Article 9.5 1356
Article 1. Purpose of This Chapter 1356
Article 2. Color and Ethnic Group
Identification 1356
Article 3. Religion 1356
Article 4. Age 1 356
Article 5. Sex 1357
Article 6. Physical or Mental
Disability 1 358
Chapter 4. Compliance and Enforcement 1359
Article 1 . State Agency Enforcement
System 1359
Article 2. Compliance Reports and
Compliance Information 1 360
Article 3. Information to
Beneficiaries, the Public,
Recipients and Employees on
Rights and
Responsibilities 1360
Article 4. Compliance Reviews and
Complaints 1361
Article 5. Hearing Process 1362
Article 6. Sanctions 1363
Arficle 7. Enforcement System
Evaluation and
Coordination 1363
Chapter 5. Relationship Between the
Secretary, DFEH and FEHC 1363
Article 1 . Incorporation of DFEH and
FEHC Employment
Discrimination Regulations
by Reference 1363
Article 2. State Agency, DFEH and FEHC
Roles 1363
•
Page XX
(7-18-2008)
Title 22
Social Security
Page
Prehospital Emergency Medical Article 2.
Services 1365 Article 3.
Emergency Medical Services
Authority and Commission on Article 4.
Emergency Medical Services — Article 5.
Conllict of Interest Code 1365
Training Standards for Child
Care Providers 1365 Article 6.
Definitions 1365 Chapter 3.
Training Requirements for
Child Care Providers 1366.2 Article 1 .
Training Program Approval 1366.2 Article 2.
Training Program Director Article 3.
and Instructor
Requirements 1366.2(a) Article 4.
Course Hours and Class Article 5.
Requirements 1366.2(c) Article 6.
Class Rosters, Course Chanter 4
Completion Documents and
Stickers 1366.2(d) . • , .
Article 1.
Fees 1366.2(e) * • i n
Article 2.
First Aid Testing for School Bus Article 3.
Drivers 1366.3
Definitions 1366.3
General 1366.3 Article 4.
Examination Standards 1366.3
Article 5.
First Aid Standards for Public Article 6.
Safety Personnel 1366.3 a • i -,
■^ Article 7.
Definitions 1366.3 Articles.
General Training Provisions 1366.4 Article 9
Training Standards 1366.4
Training Approval Options 1368 Chapter 5.
Training Standards and
Utilization for Use of the Chapter 6.
Automated External
Defibrillator by Non-Licensed
or Non-Certified Personnel 1369 Article 1
Definitions 1369 Article 2.
General Training Provisions 1369 Article 3.
AED Training Program
Requirements 1370 Article 4.
Operational AED Service
ProviderA^endor Article 5.
Requirements 1370 „,
^ Chapter 7.
Emergency Medical Article 1 .
Technician I 1371 Article 2.
Definitions 1371
Title Table of Contents
Page
General Provisions 1372
Program Requirements for EMT-
I Training Programs 1377
EMT-I Certification 1380
Maintaining EMT-I
Certification and
Recertification 1380.1
Record Keeping and Fees 1380.2
Emergency Medical
Technician-II 1380.2
Definitions 1380.2
General Provisions 1380.3
Program Requirements for EMT-
II Training Programs 1382
Certification 1387
Operational Requirements 1388
Record Keeping and Fees 1389
Emergency Medical Technician-
Paramedic 1390
Definitions 1390
General Provisions 1392
Program Requirements for
Paramedic Training
Programs 1 394
Applications and
Examinations 1399
Licensure 1400
License Renewal 1402
System Requirements 1402
Record Keeping and Fees 1402.2
DiscipUne and Reinstatement
of License 1402.3
Process for Applicant
Verification 1402.5
Process for EMT-I and EMT-II
Certification Disciplinary
Action 1402.8
Definitions 1402.8
General Provisions 1403
Evaluation and
Investigation 1406
Determination and
Notification of Action 1406
Local Responsibilities 1406.2
Trauma Care Systems 1406.3
Definitions 1406.3
Local EMS Agency Trauma
System Requirements 1408
Division 9.
Chapter 1.
Chapter 1.1.
Article 1.
Article 2.
Article 3.
Article 4.
Article 5.
Article 6.
Article 7.
Chapter 1.2.
Article 1.
Article 2.
Article 3.
Chapter 1 .5.
Article 1.
Article 2.
Article 3.
Article 4.
Chapter 1.8.
•
Article 1.
Article 2.
Article 3.
Article 4.
Chapter 2.
Article 1,
Page xxi
(7-18-2008)
Title Table of Contents BARCLAYS CALIFORNIA
Page
Arlicle 3. Trauma Center Requirements 1410
Article 4. Quality Improvement 1414.2
Article 5. Transfer of Trauma Patients 1414.2
Chapter 8. Prehospital EMS Aircraft
Regulations 1414.3
Article 1. Definitions 1414.3
Article 2. General Provisions 1414.4
Article 3. Personnel 1415
Article 4. System Operation 1415
Article 5. Equipment and Supplies,
Aircraft Specifications 1415
Chapter 9. Poison Control Center
Regulations 1416
Article 1. Definitions 1416
Article 2. General Provisions 1416
Article 3. Designation Process 1416.2
Chapter 11. EMS Continuing Education 1416.3
Article 1. Definitions 1416.3
Article 2. Approved Continuing
Education 1416.4
Article 3. Continuing Education
Records 1416.4
Article 4. CE Provider Approval
Process 1416.5
Article 5. CE Provider Denial/
Disapproval Process 1416.5
Article 6. CE Providers for EMS
Personnel 1416.5
Chapter 12. EMS System Quality
Improvement 1416.7
Article 1. Definitions 1416.7
Article 2. EMS Service Provider 1416.7
Article 3. Paramedic Base Hospital 1416.7
Article 4. Local EMS Agency 1416.8
Articles. EMS Authority 1416.8
Division 10. California Medical Assistance
Commission 1417
Chapter 1. Introduction 1417
Article 1. Definitions 1417
Article 2. Commission Meetings 1417
Article 3. Commission Staff 1417
Chapter 2. Negotiation and Approval of
Proposed Contracts 1417
CODE OF REGULATIONS Title 22
Page
Chapter 3. Confidentiality of Contract
Negotiations 1418
Chapter 4. Conflict of Interest Code 1418
Division 11 . Department of Community
Services and Development 1421
Chapter 1. Community Services Block Grant
Regulations 1421
Chapter 2. Low-Income Home Energy
Assistance Program Regulations 1428
Chapter 3. Applicant Verification
Regulations 1428.5
Chapter 4. Naturalization Services
Regulations 1428.8
Chapter 5. Department of Community Services
and Development — Conflict of
Interest Code 1428.8
Division 12. Child Care Facility Licensing
Regulations 1429
Chapter 1. Child Care Center General
Licensing Requirements 1429
Article 1 . General Requirements and
Definitions 1429
Article 2. Licensing 1431
Article 3. Application Procedures 1432
Article 4. Enforcement Provisions 1441
Article 5. Administrative Actions 1444
Article 6. Continuing Requirements 1445
Article 7. Physical Environment 1451
Subchapter 1 . (Reserved) 1454
Article I. General Requirements and
Definitions 1454
Article 2. Licensing 1454
Article 3. Application Procedure 1454
Article 4. Administrative Actions 1454
Article 5. Enforcement Provisions
(Reserved) 1454
Article 6. Continuing Requirements 1454
Article 7. Physical Environment 1456
Subchapter 2. Infant Care Center 1456
Article I. General Requirements and
Definitions 1456
Article 2. Licensing (Reserved) 1456
Article 3. Application Procedures
(Reserved) 1456
Article 4. Enforcement Provisions
(Reserved) 1456
Page xxii
(7-18-2008)
Title 22
Social Security
Page
Administrative Actions Article 4.
(Reserved) 1456
Continuing Requirements 1456 Article 5.
Physical Environment 1456.4 Article 6. -
Scliool-Age Child Care Article 7.
Center 1456.6 Subchapter 2.
General Requirements and
Definitions 1456.6 Subchapter 3.
Licensing (Reserved) 1456.6
Application Procedures 1456.6 ^m-^it. i.
Enforcement Provisions Chapter 2.
(Reserved) 1456.6 Article 1 .
Administrative Actions Article 2.
(Reserved) 1456.6
Continuing Requirements 1456.6 Article 3.
Child Care Center for
Mildly 111 Children 1456.8 Article 4.
General Requirements and Article 5.
Definitions 1456.8 Article 6.
Licensing 1456.9 Chapter 3.
Application Procedures 1456.9 Article 1.
Administrative Actions Article 2.
(Reserved) 1456.10
Enforcement Provisions Chanter 4
(Reserved) 1456.10
Continuing Requirements 1456.10
Chapters.
Physical Environment 1456.15
Family Day Care Homes for Chapter 6.
Children 1456.17 ^^j^^j^ ^
General Requirements and Subchapter 6 1
Definitions 1456.17
Licensing 1456.18 Article L
Application Procedure 1457 Article 2.
Enforcement Provisions 1463
Administrative Actions 1464.1 Article 3.
Continuing Requirements 1465 Article 4.
Physical Environment Chapter 7.
(Reserved) 1466.5 Article L
^ , ^. .. . ^ Article 2.
Department of Child Support
Services 1467 Article 3.
Article 4.
Program Administration 1467
Operations 1467 Article 5.
Definitions 1467
(Reserved) 1472.10(a) Article 6.
Plans of Cooperation 1472.10(a) Chapter 8.
Title Table of Contents
Page
Standards for Local Program
Operations (Reserved) 1472.10(b)(1)
Records Management 1472.10(b)(1)
Customer Service 1472.10(b)(2)
Staff Requirements 1472.10(b)(3)
Fiscal Administration
(Reserved) 1472.10(b)(4)
Administrative
Reporting 1472.10(b)(4)
Administrative Reports 1472.10(b)(4)
Case Intake 1472.10(b)(5)
Definitions 1472.10(b)(5)
Application and
Referral 1472.10(b)(6)
Case Opening
Requirements 1472.10(b)(6)
Case Processing 1472.10(b)(7)
Cooperation 1472.10(b)(8)
Family Violence 1472.10(b)(9)
Locate 1472.10(c)
Locate Requirements 1472.10(c)
Federal Parent Locator
Service 1472.10(d)
Establishing Paternity
(Reserved) 1472.10(e)
Review and Adjustment of
Child Support Orders 1472.10(e)
Enforcement Actions I472.l0(i)
Definitions I472.l0(i)
Immediate Enforcement
Actions 1472.100)
Income Withholding Orders . . . I472.i0(j)
Medical Support
Enforcement 1472. I0(k)
Real Property Liens I472.l0(m)
Credit Reporting 1472. I0(o)
Interstate Cases I472.l0(p)
Definitions I472.10(p)
Long Arm Jurisdiction 1472.12
General Provisions 1472.12
California As Initiating
State 1472.14
California As Responding
State 1472.16
Limited Interstate Services 1472.17
Case Closure 1472.17
Article 5.
Article 6.
Article 7.
Subchapter 3
Article 1.
Article 2.
Article 3.
Article 4.
Article 5.
Article 6.
Subchapter 4
Article 1.
Article 2.
Article 3.
Article 4.
Article 5.
Article 6.
Article 7.
Chapter 3.
Article 1.
Article 2.
Article 3.
Article 4.
Article 5.
Article 6.
Article 7.
Division 13.
Chapter L
Subchapter 1
Article L
Article 2.
Article 3.
Page xxiii
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Title Table of Contents
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
Page
Article 1. Definitions 1472.17
Article 2. Case Closure 1472.18
Chapter 9. Collection and Distribution of
Child Support 1472.20
Article 1. Definitions 1472.20
Articles. General Requirements 1472.21
Article 6. Compromise of Assigned
Arrearages — Family
Reunification 1472.21
Chapter 10. Complaint Resolution 1472.23
Page
Article 1. Definitions 1472.23
Article 2. Local Complaint Resolution
Process 1472.24
Article 3. State Hearing 1473
Chapter 11 . Quality Control 1483
Article 1. Perfomiance Measures 1483
Chapter 12. Automation Requirements
(Reserved) 1485
Chapter 13. Conflict of Interest Code 1485
Page xxiv
(7-18-2008)
i&.
Barclays Official
California
Code of
Regulations
Title 22. Social Security
Division 3. Health Care Services
Vol. 29
XMOIVISOIM
* ^
\A/EST
Barclays Official California Code of Regulations
425 Market Street • Fourth Floor • San Francisco, CA 94105
800-888-3600
Title 22
Health Care Services
Table of Contents
Division 3. Health Care Services
Table of Contents
Page
Page
Subdivision 1.
California Medical Assistance
Program 307
Chapter 1. ]
[ntroduction 307
§ 50000.
Meaning of Words.
§50001.
Department.
§ 50002.
Director.
§ 50003.
Medi-Cal Program.
§ 50004.
Medi-Cal Program Administration.
§ 50005.
Medi-Cal Regulations.
§ 50006.
Conformity with Federal
Requirements.
§ 50007.
Fiscal Intermediary.
§ 50008.
Liens.
§ 50009.
Medi-Cal Consultant.
§50009.1.
Medical Review.
§ 50009.2.
Medical Review Team.
§ 50009.3.
Health Care Services.
Chapter 2.
Determination of Medi-Cal
Eligibility and Share of Cost 308
icle 1.
Definitions, Abbreviations
and Program Terms 308
§50011.
Definitions — General.
§ 50012.
Abbreviations.
§ 50013.
Adequate Consideration.
§ 50014.
Adult.
§50015.
Adverse Action.
§ 50016.
Aid.
§ 50017.
Aid Category.
§50018.
Aid Code.
§ 50019.
Aid to Families with Dependent
Children (AFDC).
§ 50020.
Aid to the Potentially
Self-Supporting Blind (APSB).
§50021.
Applicant.
§ 50022.
Application.
§ 50023.
Approval of Eligibility.
§ 50024.
Beneficiary.
§ 50025.
Benefits Review Unit (BRU).
§ 50025.3.
Board and Care.
§ 50025.5.
Burial Insurance.
§ 50025.6.
California Standard Nomenclature
(CSN), 1979.
§ 50026.
Cash Grant.
§ 50027.
Certification Date for Claims
Clearance.
§ 50028.
Certification — Effective Date.
§ 50029.
Certification for Medi-Cal.
§ 50029.5.
Certified Long-Term Care
Insurance Policy or Certificate.
§ 50030.
Child.
§50031.
Child Health and Disability
Prevention Program (CHDP).
§ 50032.
Competent.
§ 50033.
Contiguous Property.
§ 50034.
Conversion of Property.
§ 50035.
County Agency.
§ 50035.5.
County Cash-Based Medi-Cal
Eligibility.
§ 50036.
County Department.
§ 50036.5.
County Case Error Rate.
§ 50036.6.
Dependent Relative.
§ 50037. Eligibility and Assistance Standards
Manual (EAS).
§ 50037.5. Eligibility Quality Control.
§ 50038. Eligibility Services.
§ 50038.5. Emergency Assistance (EA).
§50039. Encumbrances of Record.
§ 50040. Fair Market Value.
§50041. Family Member.
§ 50041 .5. Federal Poverty Level.
§50042. Foster Child.
§ 50043. Heirloom.
§ 50044. Home.
§ 50045. Immigration and Naturalization
Service (INS).
§ 50045.1. Impairment Related Work Expenses
(IRWE).
§ 50045.3. Income and Eligibility Verification
System.
§ 50045.5. In-Home Supportive Services.
§ 50046. Inmate.
§ 50047. Institution.
§ 50048. Institution — Medical.
§ 50049. Institution — Mental Diseases.
§ 50050. Institution — Nonmedical.
§50051. Institution — Private.
§ 50052. Institufion— Public.
§ 50052.5. Institution — Tuberculosis.
§ 50053. Intraprogram Status Change.
§ 50054. Interprogram Transfer.
§ 50054.5. Life Insurance.
§ 50054.7. Limited Service Status.
§ 50055. Linked.
§ 50056. Long-Term Care (LTC).
§ 50057. Marriage.
§ 50058. Medi-Cal.
§ 50059. Medi-Cal Card.
§ 50059.5. State Dollar Error Rate.
§ 50059.6. Federal Standard.
§ 50059.7. State Caused Errors.
§ 50060. Medi-Cal Family Budget Unit
(MFBU).
§ 50060.5. Medi-Cal-Only Eligibility.
§ 50060.6. Medical Support.
§ 50061. Medically Indigent (MI) Person or
Family.
§ 50062. Medically Needy (MN) Person or
Family.
§ 50063. Minimum Basic Standard of
Adequate Care (MBSAC).
§50063.5. Minor Consent Services.
§ 50064. Multiple Dwelling Unit.
§ 50064.5. Nonrecurring Lump Sum Payment.
§ 50065. Obligate.
§ 50066. Other Public Assistance (Other PA)
Recipient.
§ 50067. Overpayment.
§ 50068. Parent.
§ 50068.5. Parent— Minor.
§ 50069. Parents — Unmarried.
§ 50069.5. Parent — Unmarried Minor.
§ 50070. Patient.
§ 50071 . Persons Living in the Home.
§ 50071.5. Prepaid Health Plan.
§ 50071 .6. Prepaid Health
Plan — Comprehensive.
Page
(7-18-2008)
Table of Contents
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
Page
§ 50071.8. Primary Care Case Management
(PCCM) Plan.
§ 50072. Property — Corrununity.
§ 50073. Property — Personal.
§ 50074. Property— Real.
§ 50075. Property — Separate.
§ 50076. Property — Share of Community.
§ 50077. Public Agency.
§ 50078. Public Assistance (PA) Recipient.
§ 50079. Public Funds.
§ 50079.5. Publicly Operated Community
Residence.
§ 50079.6. Qualified Disabled and Working
Individual.
§ 50079.7. Qualified Medicare Beneficiary.
§50080. Quality Control.
§50081. Reapplication.
§ 50082. Recipient.
§ 50083. Redetermination.
§ 50084. Relative.
§ 50085. Relative— Caretaker.
§ 50086. Repayment.
§ 50087. Residence.
§ 50088. Responsible Relative.
§ 50089. Restoration.
§50090. Share of Cost.
§50091. Share of Encumbrances.
§ 50091.5. Specified Low-Income Medicare
Beneficiary.
§ 50092. Spenddown.
§ 50093. State Data Exchange (SDX).
§ 50094. Steppai-ent.
§ 50095. Supplemental Security Income/State
Supplemental Program (SSI/SSP).
§ 50095.1 . Title 11 Disregard Person.
§ 50095.5. Therapeutic Wages.
§ 50095.7. Title II Disregard Person.
§ 50096. Transfer of Property.
§ 50097. Verification.
Article 2. Administration 317
Page
§ 50127. Persons with a Guardian.
§ 50129. County of Responsibility — Persons
Placed in State Hospitals by County
Mental Health Agencies or Regional
Centers for the Developmentally
Disabled.
§50101.
County Department
Responsibilities.
§50103.
Civil Service or Merit Systems.
§ 50105.
Staffing Requirements.
§50106.
Staff Training.
§ 50107.
Civil Rights.
§50109.
Reports.
§50110.
Medi-Cal Case.
§50111.
Case Records and Confidentiality.
§50113.
Forms.
§50115.
Quality Control — County
Cooperation.
§50116.
Medi-Cal Fiscal Penalties.
§50116.5.
Appeal of Quality Control Review
Findings.
§50117.
Calculation of Medi-Cal Fiscal
Penalties.
§50118.
Application of Medi-Cal Fiscal
Penalties.
§50118.5.
Reconsideration of a Medi-Cal
Fiscal Penalty.
§50119.
County Corrective Action
Requirements.
icle 3.
County of Responsibility for
Determination of Medi-Cal
Elio
ibilitv
§ 50120. County of Responsibility.
§ 50121. Persons Eligible Under SSI/SSP
§ 50123. County of Responsibility — Persons
with a Family.
§ 50125. County of Responsibility — Persons
with No Family.
§ 50126. County of Responsibility — Persons
Eligible Under Special Programs.
§50131.
Placement in Long-Term Care After
Release from a State Hospital.
§50133.
County of
Responsibility — Deceased Persons.
§50134.
County of Responsibility — Persons
Absent from the State.
§50135.
Application Made in County Other
Than County of Responsibility.
§ 50136.
Intercounty Transfer Procedure.
§50137.
Intercounty Transfer — Effective
Date of Disconiinuance/Eligibility.
§ 50138.
Intercounty Transfer — Blindness or
Disability Deterini nation Pending.
Article 4.
Beneficiary Application
Process
§50141.
Application Process — General.
§50142.
Screening.
§50143.
Persons Who May File an
322
§ 50145.
§50146.
§ 50147.
§50147.1.
§ 50148.
§ 50149.
§50151.
§ 50153.
§50155.
§ 50157.
§50159.
§50161.
§ 50163.
§ 50165.
§ 50166.
§ 50167.
§ 50167.2.
§ 50167.5.
§ 50168.
§50169.
§50171.
§50172.
§50173.
§50175.
§50176.
§ 50177.
§50179.
Application for Medi-Cal.
Medi-Cal Application for Persons
Applying for a Cash Grant or
In-Home Supportive Services.
Medi-Cal Application for Persons
Applying for In-Home Supportive
Services.
Application for Medi-Cal Only.
Child Applying for Medi-Cal.
Apphcation for Retroactive
Medi-Cal.
Apphcation Form.
Date of the Apphcation.
Medi-Cal Apphcation — Process for
All Programs.
Withdrawal of
Application — Request for
Discontinuance.
Face-to-Face Interview.
Statement of Facts.
Statement of Facts Form.
Persons Who May Complete and
Sign the Statement of Facts.
Filing the Statement of Facts.
Obtaining Information for the
Completion of the Statement of
Facts.
Verification — Prior to Approval.
Verification of Income — lEVS
Requirements.
Verification of Unearned Income
Information from Internal Revenue
Service (IRS) or Franchise Tax
Board (FTB) — lEVS Requirements.
Verification — Within 60 Days.
Additional Verification
Requirements.
Clarification of Statement of Facts.
Verification by Signature.
Eligibility Determination.
Denial or Discontinuance Due to
Lack of Information,
Noncooperation or Loss of Contact.
Discontinuance Due to Death.
Promptness Requirement.
Notice of Action — Medi-Cal-Only
Determinations or
Redeterminations.
Page ii
(7-18-2008)
Title 22
Health Care Services
Table of Contents
§50179.3.
§50179.7.
§ 501 80.
§50181.
§50182.
§50183.
§ 50183.5.
§50184.
§50185.
§ 50185.5.
§50186.
§50187.
§50189.
§ 50191.
§ 50192.
§ 50193.
§ 50195.
§ 50197.
§ 50199.
Article 5.
§50201.
§ 50203.
§ 50205.
§ 50207.
§ 50209.
§50211.
§ 50213.
§ 50215.
§ 50216.
§ 50216.5.
§ 50217.
§ 50219.
§50221.
§ 50223.
§ 50227.
§ 50237.
§50241.
§ 50243.
§ 50244.
§ 50245.
§ 50247.
§ 50249.
§50251.
§ 50253.
§ 50255.
§ 50256.
§ 50257.
Page
Notice of Action — County Cash
Assistance Determinations or
RedeteriTiinations Which Affect
County Cash-Based Medi-Cal
Eligibility.
Notice of Action — Medi-Cal
EUgibility of SSI/SSP Recipients.
Action Prior to Denial of
Application.
Action Following Denial of an
SSI/SSP Application.
Corrective Action on Denied
Applications.
Transfer Between Programs.
Action Following Medi-Cal
Discontinuance by the Department.
RefeiTal for Social Services.
Applicants' and Beneficiaries'
General Responsibilities.
Medi-Cal Managed Care Plan
Assigned Enrollment Prior to
Two-Plan Model Implementation or
for Geographic Areas Not
Designated for Two-Plan Model
Implementation.
Unconditionally Available Income.
Social Security Numbers and Health
Insurance Claim Numbers.
Redetermination — Frequency and
Process.
Status Reports.
Testing Techniques for
Redeterminations, Status Reporting
and Verification.
Beginning Date of Eligibility.
Period of Eligibility.
Retroactive Eligibility.
Certification for
Medi-Cal — Completion .
Medi-Cal Programs 336.7
Medi-Cal Programs — General.
Medically Needy Program.
Linkage to AFDC.
Deprivation — ^Relinquishment for
Adoption.
Deprivation — Deceased Parent.
Deprivation — Physical or Mental
Incapacity of a Parent.
Deprivation — Absent Parent.
Deprivation — Unemployed Parent.
Good Cause — Refusal of
Employment.
Linkage to AFDC — Placement in
Foster Care.
Linkage to SSI/SSP
Blindness.
Age.
Disability.
Public Assistance Cash Grant
Programs.
Other Public Assistance Program.
Children Not in School or Training.
Four Month Continuing Eligibility.
Nine Month Continuing Eligibihty.
In-Home Supportive Services
(IHSS).
Twenty Percent Social Security
Increase.
Medically Needy Program.
Medically Indigent Program.
Miscellaneous Special Programs.
Repatriate Program.
Qualified Disabled and Working
Individual Program.
Refugee Medical Assistance (RMA)
and Entrant Medical Assistance
(EMA).
Page
§ 50258.
Qualified Medicare Beneficiary
Program.
§50258.1.
Specified Low-Income Medicare
Beneficiary Program (SLMB).
§ 50259.
Indochinese Refugee Status.
§ 50260.
60-Day Postpartum Services
Program.
§ 50261 .
Special Medi-Cal Dialysis
Programs.
§ 50262.
Special Zero Share of Cost
Programs for Pregnant Women and
Infants.
§ 50262.3.
Continued Eligibility Program for
Pregnant/Postpartum Women and
Infants.
§ 50262.5.
Special Zero Share of Cost Program
for Children of Age One Up to Age
Six (133 Percent Program).
§ 50262.6.
Special Zero Share of Cost Program
for Children of Age Six Up to Age
Nineteen (100 Percent Program).
§ 50262.7.
Targeted Case Management
Services Program.
§ 50263.
MC 800 Program.
§ 50264.
Medi-Cal Special Treatment
Programs.
§ 50265.
Medi-Cal Aid Codes.
§ 50268.
Tuberculosis (TB) Program.
e6.
Institutional Status
341
§ 50271. Institutional Status — General.
§ 50273. Medi-Cal Ineligibility Due to
Institutional Status.
§ 50275. Voluntary Inmates.
§ 50279. Limitations of Institutional Status.
Article 7. Alienage, Citizenship and
Residence 342
§ 50301.
Citizenship or Immigration Status
for Full Medi-Cal Benefits.
§50301.1.
Documentation of Status as a
Citizen or National of the United
States.
§50301.2.
Documentation of Status as an AUen
Lawfully Admitted for Permanent
Residence.
§50301.3.
Documentation of Status as an Alien
Permanently Residing in the United
States Under Color of Law
(PRUCOL).
§50301.4.
Documentation of Status as an
Amnesty AUen.
§50301.5.
Opportunity to Document
Satisfactory Immigration Status.
§ 50301.6.
Verification of Satisfactory
Immigration Status.
§ 50302.
Restricted Medi-Cal Benefits for
Certain Aliens.
§50302.1.
Limitations on Medi-Cal Benefits
for Aliens.
§ 50302.2.
Limitations on Medi-Cal Benefits
for Aliens.
§ 50303.
Alien Status Verification.
§ 50304.
Written Declaration of Status as a
Citizen of the United States, a
National of the United States, or an
Alien.
§ 50305.
Documentation of an Alien's Legal
Status.
§ 50310.
WR 6 Procedure.
§50311.
Lawful Presence in the United
States.
§ 50313.
Legal Entry for a Limited Period.
§ 50320.
California Residence— General.
§50320.1.
California Residence — Evidence.
§ 50320.2.
California Residency — County
Verification.
§50321.
Temporary Absence from the State.
Page iii
(7-18-2008)
Table of Contents
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
Page
Page
§ 50323.
Absence from the State for More
Than 60 Days.
§ 50325.
Death During Absence from the
State.
§ 50327.
Persons Living on Land Leased or
Owned by the United States.
§ 50329.
Persons on Parole from Correctional
or Other Institutions.
§50331.
United States Citizen Children of
Aliens.
§ 50333.
Foster Children and Institutionalized
Persons Placed Out-of-State.
§ 50334.
Out-of-State Foster Children and
Institutionalized Persons Placed in
California.
§ 50336.
Other Persons in Out-of-State
Institutions.
§ 50338.
Other Persons in California
Institutions.
Article 8.
Responsible Relatives and
Unit Determination 348
§50351.
Responsible Relatives.
§50371.
Medi-Cal Family Budget Unit.
§ 50373.
Medi-Cal Family Budget Unit
Determination, No Family Member
in LTC or Board and Care.
§ 50374.
MFBU Determination— Child Stays
Alternately with Each Parent.
§ 50375.
Medi-Cal Family Budget Unit
Determination, Stepparent Cases.
§ 50377.
Medi-Cal Family Budget Unit
(MFBU) Deternunation, Family
Member in Long-Term Care or
Board and Care.
§ 50379.
Ineligible Members of the Medi-Cal
Family Budget Unit.
§ 50381.
Persons Excluded from the
Medi-Cal Family Budget Unit.
Article 9.
Property 350.3
§ 50401.
Property Evaluation.
§ 50402.
Availability of Property.
§ 50403.
Treatment of Property: Separate and
Community Property.
§ 50404.
Owner of Propeity.
§ 50405.
Contracts of Sale.
§ 50406.
Conversion or Transfer of Property.
§ 50407.
Conversion of
Property — Treatment.
§ 50408.
Transfer of Property Which Does
Not Result in Ineligibility.
§ 50409.
Transfer of Property Which Results
in Ineligibility.
§ 50410.
Transfer of Property with Retention
of a Life Estate.
§ 50411.
Period of Ineligibility Due to
Transfer of Property.
§ 50412.
Market Value of Property.
§ 50413.
Encumbrances.
§ 50414.
Share of Encumbrances
Determination.
§ 50415.
Net Market Value of Property.
§ 50416.
Utilization Requirements.
§50417.
Utilization — Good Cause.
§ 50418.
Exemption of Property.
§ 50419.
Property Reserve.
§ 50420.
Property Limit.
§ 50420.5.
Separation of Community Property:
Spouse in Long-Term Care Facility.
§50421.
Limits and Methods of Property
Determination for the Qualified
Medicare Beneficiary (QMB) or the
Specified Low-Income Medicare
Beneficiary (SLMB).
§50421.5.
§ 50422.
§ 50423.
§ 50425.
§ 50426.
§ 50427.
§ 50428.
§ 50429.
§50431.
§ 50433.
§ 50435.
§ 50437.
§ 50441.
§ 50442.
§ 50443.
§ 50445.
§ 50446.
§ 50448.
§ 50448.5.
§ 50449.
§50451.
§ 50453.
§ 50453.5.
§ 50453.7.
§ 50454.
§ 50454.5.
§ 50455.
§ 50456.
§ 50457.
§ 50459.
§50461.
§ 50463.
§ 50465.
§ 50467.
§ 50469.
§50471.
§ 50473.
§ 50475.
§ 50476.
§ 50477.
§ 50479.
§ 50481.
§ 50483.
§ 50485.
§ 50487.
§ 50489.
§50489.1.
§ 50489.5.
§ 50489.9.
Article 10.
§50501.
§ 50503.
§ 50505.
Limits and Methods of Property
Determination for the Qualified
Disabled and Working Individual
(QDWI).
Liens.
Items of Property to Be Considered.
Property Used As a Principal
Residence.
Property Used to Purchase a
Principal Residence.
Other Real Property.
Liens.
Value and Division of Real Property
Where Part Is Used As a Home.
Land Contiguous to the
Home — Value and Division.
Single Family Dwelling Used in
Part As a Business — Value and
Division.
Multiple Dwelling Unit — Value and
Division.
Land with More Than One
Building — Value and Division.
Mortgages, Deeds of Trust and
Other Promissory Notes.
Life Estate.
American Indian's Interest in Land
Held in Trust by United States
Government.
Federal Payments to Indians and
Alaskan Natives — Property.
Payments to Victims of the National
Socialist Persecution.
Payments to Victims of
Crimes — Treatment as Property.
Relocation Assistance Benefits.
Earned Income Tax Credit.
Cash on Hand.
Checking and Savings Accounts.
Savings of a Child.
Long-Term Care Insurance
Exemption.
Income Tax Refunds.
California Franchise Tax Board
Payments.
Lump Sum Payments.
Stocks, Bonds, Mutual Funds.
United States Savings Bonds.
Promissory Notes.
Motor Vehicles.
Boats, Campers, Trailers.
Household Items.
Personal Effects.
Recreational Items.
Musical Instruments.
Livestock and Poultry.
Life Insurance.
Burial Insurance.
Burial Plots, Vaults and Crypts.
Burial Funds.
Disaster and Emergency Assistance
Payments.
Loans.
Business Property.
Stocks Held by Natives of Alaska.
Trusts — General.
Medicaid Qualifying Trusts.
OBRA 93 Trusts Established On or
After August II, 1993.
Trusts Other than Those Described
in 50489.1 or 50489.5.
Income 362.2
Income — General.
Gross Earned Income.
Net Profit from Self-Employment.
Page iv
(7-18-2008)
Title 22
Health Care Services
Table of Contents
Page
Page
§ 50507. Gross Unearned Income.
§ 50508. Net Income from Property.
§50509. Income in Kind.
§ 5051 1 . Value of Income in Kind.
§50512. Ownership of Income.
§50513. Availability of Income.
§ 50515. Unavailable Income.
§ 505 17. Apportionment of Incoine over
Time.
§ 505 17.1. Apportionment of Income
Exemptions and Deductions.
§ 505 18. Fl uctuati ng Income .
§ 50519. Income Exemptions and
Deductions — General.
§ 50521. Payments Exempt from
Consideration as Income.
§ 50523. Property Tax Refunds.
§ 50523.5. California Franchise Tax Board
Payments.
§ 50524. Child/Spousal Support Received by
AFDC-MN and MI Family
Members.
§ 50525. Public Assistance and General
Relief Grants.
§ 50526. Work Incentive Program (WIN).
§ 50527. Social Services.
§ 50528. Assistance Based on Need.
§ 50529. Federal Housing Assistance.
§ 50530. Training Expenses.
§ 5053 1 . Foster Care Payments.
§ 50533. Exempt Loans, Grants, Scholarships
and Fellowships.
§ 50534. Payments to Victims of
Crimes — Treatment as Income.
§ 50535. Relocation Assistance Benefits.
§ 50535.5. Disaster and Emergency Assistance
Payments.
§ 50536. Payments to Victims of the National
Socialist Persecution.
§ 50537. Federal Payments to Indians and
Alaskan Natives — Income.
§ 50538. VISTA Payments.
§ 50539. Job Training Partnership Act (JTPA)
Payments.
§ 50540. Executive Volunteer Programs.
§ 50541 . Senior Citizen Volunteer Programs.
§ 50542. Irregular or Infrequent Income.
§ 50543. Student Exemption.
§ 50543.5. Earned Income Tax Credit.
§ 50544. Earnings of Children Under Age 1 4.
§ 50545. Deductions from Income.
§ 50547. Educational Expenses.
§ 50549. Deductions from Income — MFBUs
Which Include Aged, Blind or
Disabled MN Persons.
§ 50549.1 . Support Payment from an Absent
Parent.
§ 50549.2. Any Income Deduction — Unearned
Income.
§ 50549.3. Guardian and Conservator Fees.
§ 50551. Student Deduction.
§ 50551.1. Thirty Dollars Plus
One-Third— MFBUs Which
Include Aged, Blind or Disabled
MN Persons.
§ 50551 .2. Any Income Deduction — Earned
Income.
§ 50551 .3. Sixty-Five Plus One-Half.
§ 5055 1 .4. Work Expenses of the Blind.
§ 50551.5. Income Necessary to Achieve
Self-Support.
§ 50551.6. Cost of In-Home Supportive
Services— ABD-MN and SGA
Disabled.
§ 50553. Deductions from Earned
Income— AFDC-MN, MI or
Ineligible Members of the MFBU.
§50553.1.
Deduction for Work Expenses.
§ 50553.2.
Deduction for Dependent Care.
§ 50553.3.
Thirty Dollars Plus One-Third.
§ 50553.5.
Deduction for Dependent Care.
§ 50554.
Court Ordered Alimony or Child
Support.
§ 50554.5.
Child/Spousal Support Received by
AFDC-MN and MI Family
Members.
§ 50555.
Deductions from Any Income — All
MN or Ml Programs.
§ 50555.1.
Income of an MN or Ml Person
Used to Determine Public
Assistance Eligibility of Another
Family Member.
§ 50555.2.
Health Insurance Premiums.
§ 50555.3.
Court Ordered Child Support.
§ 50555.4.
Special Deduction for Aged, Blind
or Disabled MN.
§ 50557.
Treatment of Income.
§ 50558.
Income of Persons Excluded from
the MFBU.
§ 50559.
Income Deemed Available from the
Stepparent.
§ 50561.
Treatment — Stepparent Cases.
§ 50563.
Treatment of Income — Aged, Blind
or Disabled MN Person or Person's
Spouse in LTC or Board and Care.
§ 50564.
Treatment of Income — Persons No
Longer Receiving Title XVI Due to
a Cost of Living Increase in OASDI
Benefits Under Title 11.
§ 50565.
Projection of Anticipated Income.
§ 50567.
Adjustment for Decreases in
Income.
§ 50569.
County Failure to Change Income.
§ 50570.
Income Determination and Limit for
the Qualified Medicare Beneficiary
(QMB) or the Specified
Low-Income Medicare Beneficiary
(SLMB).
§ 50571.
Income Determination and Limit for
the Qualified Disabled and Working
Individual (QDWI).
Article 11.
Maintenance Need
§50601.
Maintenance Need — General.
§ 50603.
Maintenance Need — Persons Living
in the Home.
§ 50604. Maintenance Need — Family
Members Maintaining Separate
Residences with Eligibility
Determined As a Single MFBU.
§ 50605. Maintenance Need — Persons in
Long-Term Care.
Article 12. Share of Cost 375
§ 5065 1 . Share of Cost— General .
§ 50652 . Share of Cost Period .
§ 50653. Determination of Share of Cost.
§ 50653.3. Changes Which Decrease the Share
of Cost.
§ 50653.5. Changes Which Increase the Share
of Cost.
§ 50653.7. Changes in Share of Cost
Determination Due to
Administrative Error.
§ 50655. Record of Health Care
Costs — Share of Cost.
§ 50657. Completion of Form MC 177S.
§ 50658. Form MC 177S Processing.
§ 50659. Long-Term Care Patients with a
Share of Cost.
§ 50660. MFBUs Which Include a Title II
Disregard Person.
Article 13. Period of Eligibility 378
§ 50701 . Beginning Date of Eligibility.
Page V
(7-18-2008)
Table of Contents
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
Page
§ 50703. Period of Eligibility.
§50710. Retroactive Eligibility.
§ 50715. Certification for
Medi-Cal — Completion.
Article 14. Medi-Cal Card Use and
Issuance 379
§ 5073 1 . Medi-Cal Card Use.
§ 50732. Medi-Cal — Signature Requirement.
§ 50733. Medi-Cal Card — Authorization for
Services.
§ 50735. Locations at Which Medi-Cal Card
May Be Used.
§ 50737. Format of Medi-Cal Card.
§ 50739. Full Complement and POE Only
Medi-Cal Cards.
§ 50740. Medi-Cal Cards for Restricted
Medi-Cal Benefits to Certain
Aliens.
§ 50741. Medi-Cal Caid Issuance by the
Department.
§ 50742. Limitations on Eligibility Reports
and Card Issuance Requests
Submitted by the County
Department.
§ 50743. Medi-Cal Card Issuance by the
County Department — No Share of
Cost.
§ 50745.
Medi-Cal Card Issuance by the
County Department — Share of Cost.
§ 50746.
Limitation on Medi-Cal Card
Issuance.
§ 50749.
Control of County Issued Medi-Cal
Cards.
§ 50751.
Report of Eligibles.
icle 15.
Other Health Care Coverage
and Medicare Buy-In
Coverage 382
§50761.
Other Health Care
Coverage — General.
§ 50763.
Beneficiary Responsibility — ^Other
Health Care Coverage.
§ 50765.
County Department
Responsibility — Other Health Care
Coverage.
§ 50769.
Department Responsibility — Other
Health Care Coverage.
§ 50771.
Recovery of Third Party Payments.
§50771.5.
Determination of Good Cause for
Refusal to Cooperate.
§ 50772.
Veterans Aid and Attendance
Payments.
§ 50773.
Medicare Buy-in.
§ 50775.
Medicare Coverage.
§ 50777.
Requirement to Apply for
Medicare.
§ 50778.
Other Health Care Coverage
Premium Payment.
icle 16.
Overpayments, Fraud and
Improper Utilization 386
§50781.
Potential Overpayments.
§50781.5.
Potential
Overpayments — Unreported Other
Health Coverage.
§ 50782.
Fraud.
§ 50783.
County Action on Potential
Overpayment.
§ 50785.
Action on
Overpayment — Department of
Health.
§ 50786.
Action on
Overpayment — Department of
Health Services or County Unit
Contracted to Collect
Overpayments.
Page
§ 50787. Demand for Repayment.
§ 50789. Failure to Repay.
§50791. Medi-Cal Overpayments
Fraud— AFDC Cash Grant.
§ 50793. Utilization Restrictions.
Article 17. Dialysis Medi-Cal Program 386.3
§ 50801 . Medi-Cal Special Treatment
Programs — General.
§ 50803. Medi-Cal Special Treatment
Programs Beneficiary.
§ 50805. Real Property— Medi-Cal Special
Treatment Programs
§ 50807. Personal Property— Medi-Cal
Special Treatment Programs.
§ 50809. Gross Income — Medi-Cal Special
Treatment Programs.
§50811. Annual Net Worth.
§50813. Percentage Obligation.
§ 50815. Application Process — Medi-Cal
Special Treatment Programs.
§50817. Eligibility
Requirements — Medi-Cal Special
Treatment Programs.
§50819. Verification
Requirements — Medi-Cal Special
Treatment Programs.
§ 50820. Eligibility Determination for
Medi-Cal Special Treatment
Programs.
§ 5082 1 . Medi-Cal Special Treatment
Program.
§ 50823. Beginning Date of
Eligibility — Medi-Cal Special
Treatment Programs.
§ 50825. Determination of Annual Net
Worth.
§ 50827. Determination and Application of
Percentage Obligation — Medi-Cal
Special Treatment Programs.
§ 50829. Declaration of Acceptance.
§ 5083 1 . Share of Cost— Medi-Cal Special
Treatment Programs — Supplement
Beneficiary.
Article 18. State Administrative
Hearings 389
§ 50951. Right to State Hearing.
§ 50953. State Hearing Procedures.
§ 50955. Fair Hearing — Assistance in Filing.
Article 19. Medi-Cal Estate Recovery 390
§ 50960. Definitions.
Chapter 2.5. Third Party Liability 390
Article 1 . Definitions 390
§ 50960.2, Annuity.
§ 50960.4. Applicant.
§ 50960.6. Dependent.
§ 50960.9. Equity Interest.
§50960.12. Estate.
§50960.15. Estate Hearing.
§ 50960.21 . Fair Market Value.
§ 50960.23. Heir.
§ 50960.26. Irrevocable Transfer.
§ 50960.29. Life Estate.
§ 50960.32. Revocable Transfer.
§ 50960.34. Survivor.
§ 50960.36. Voluntary Post Death Lien.
Article 2. Estate Recovery 392
§50961. Estate Claims.
§ 50962. Notification.
§ 50963. Substantial Hardship Criteria.
§ 50964. Estate Hearing.
§ 50965. Voluntary Post Death Lien.
§ 50966. Claim Exemption.
Page vi
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Title 22
Health Care Services
Table of Contents
Chapter 3.
Article
§
§
§
§
1.
51000.
51000.
51000.
51000.
51000.
51000.
51000.
51000.
51000.
51000.
51000.
51000.
51000.
51000.
51000.
51000.
51000.
51000.
51000.
Page
Health Care Services 392.4
Application and Enrollment 392.4
Page
1.
1.1.
2.
3.
4.
5.
6.
6.1.
7.
9.
10.
10.1.
11.
12.
13.
14.
15.
§51000.15.1.
51000.
51000.
51000.
51000.
51000.
51000.
51000.
51000.
51000.
51000.
51000.
51000.
51000.
51000.
51000.
51000.
51000.
16.
17.
18.
19.
20.
20.1.
20.9.
21.
22.
23.
24.
24.1.
25.
25.1.
25.2.
26.
30.
§51000.31.
§ 51000.32.
Agent.
Applicant.
Application or Application Package.
Beneficiary.
Business Address.
Business Telephone.
Capital.
Change of Ownership.
Deactivate.
Enrolled or Enrollment in the
Medi-Cal Program.
Group Provider Number.
Indirect Ownership Interest.
Line of Credit.
Location.
Mailing Address.
Managing Employee.
Ownership Interest.
Pay To Address.
Person with an Ownership or
Control Interest.
Preenrollment Period or
PreenroUment.
Provider Group.
Provider Group Applicant.
Provider Identification Number or
PIN.
Provider.
Provider Number.
Provider Transferor.
Rendering Practitioner.
Rendering Provider.
Rendering Provider Number.
Significant Business Transaction.
Subcontractor.
Successor Liability with Joint and
Several Liability.
Supplier.
Suspend.
Transferee Applicant.
Wholly Owned Supplier.
Medi-Cal Provider Application for
Enrollment, Continued Enrollment,
or Enrollment at a New, Additional,
or Change in Location.
Medi-Cal Provider Group or
Rendering Provider Application for
Enrollment, Continued Enrollment
or Enrollment at a New, Additional
or Change in Location.
Requirements for Successor
Liability with Joint and Several
Liability.
§51003.1.
§51003.3.
§51003.7.
Provider Appeal Process for
Treatment Authorization Requests
(TARs).
Prior Authorization of Personal Care
Benefits.
Prior Authorization Under Primary
Caie Case Management Contracts.
•
§51000.35.
Disclosure Requirements.
§ 51000.40.
Reporting of Additional or Changed
Information to Provider
Applications.
§ 51000.45.
Provider Agreement.
§51000.50.
Application Review Criteria and
Notice of Department Action.
§51000.51.
Provisional Provider and Preferred
Provisional Provider Status.
§ 51000.52.
Provider Numbers.
§ 51000.53.
Deactivation of a Provider
Number(s).
§51000.55.
Requirements for Continued
Enrollment.
§ 51000.60.
Established Place of Business.
Article 1.3.
General Provisions 394. ii
§51001.
Beneficiary.
§51002.
Beneficiary BiUing.
§ 51003.
Treatment Authorization Requests
(TARs).
§51004.
Copayment.
§ 51005.
Other Health Care Coverage.
§51006.
Out-of-State Coverage.
§51007.
Discrimination.
§51008.
Bills for Service.
§51008.1.
Upper Billing Limit.
§51008.5.
Billing Procedures for Claims
Delayed by Good Causes.
§ 51009.
Confidential Nature of Records.
§51011.
Identification of Beneficiary.
§51011.1.
Year 2000 Alternate Procedure for
Verification of Eligibility.
§51013.
California Children Services.
§ 51014.
Vocational Rehabilitation Services.
§51014.1.
Fair Hearing Related to Denial,
Termination or Reduction in
Medical Services.
§ 51014.2.
Medical Assistance Pending Fair
Hearing Decision.
§51015.
Provider Grievances and
Complaints.
§51015.1.
Special Claims Review Appeals.
§51015.2.
Providers of Personal Care Services
Grievance and Complaints.
Article 1.5.
Provider Audit Appeals 396.3
§51016.
Definitions.
§51017.
Provider Audit Hearing.
§51018.
Home Office — Chain Organization
Related Entities.
§51019.
Amended Cost Reports.
§ 51020.
Amended Audit Report.
§51021.
Exit Conference and Audit Report.
§ 51022.
Request for Hearing.
§51023.
Informal Level of Review.
§51024.
Request for Formal Hearing.
§51025.
Notice of Formal Hearing.
§ 51026.
Department Mailings.
§ 51027.
Time and Place of Informal Level of
Review and Formal Hearing.
§ 51028.
Merger of Successive Requests for
Hearings.
§51029.
Consolidation of Proceedings.
§51030.
Hearing Officer's Authority.
§51031.
Severance of Issues.
§ 51032.
Discovery.
§51033.
Subpoenas and Witnesses.
§ 51034.
Depositions.
§51035.
Affidavits.
§ 51036.
Preparation for Formal Hearing.
§ 51037.
Conduct of Formal Hearing.
§51038.
Official Notice.
§ 51039.
Continued or Further Hearings.
§ 51040.
Evidence.
§51041.
Representation at a Formal Hearing.
§ 51042.
Oral Argument and Briefs.
§51043.
Disqualification of Hearing Officer.
§ 51044.
Decision.
§51045.
Reconsideration.
§ 51046.
Judicial Review.
§51047.
Recovery of Overpayments.
§ 51048.
Administrative Review of
Performance Under Selective
Provider Contracts.
Article 1.6.
Skilled Nursing Facility and
§51048.1.
Intermediate Care Facility
Certification Appeals
Procedure
Limitations.
402
Page vii
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BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
Page
Page
§5
048.2
§5
048.3
§5
048.4
§5
048.5
§5
048.6
§5]
048.7
§5]
048.8
§51
048.9
Article 2
§51
050.
§5
051.
§5]
052.
§5]
053.
§5
055.
§51
056.
§5]
056.1
§51
056.2
§5]
057.
§51
059.
§5
060.
§5
061.
§5
063.
§5
065.
§5
066.
§5
067.
§5
069.
§5
070.
§5
071.
§5
073.
§5
074.
§5
074.5
§5
1075.
§5
1077.
§5
1079.
§5
1081.
§5
1082.
§5
082.1
§5
1083.
§5
085.
§5
087.
§5
089.
§5
1090.
§5
091.
§5
093.
§5
094.
§5
094.1
§5
095.
§5
096.
§5
1097.
§5
098.
§5
098.5
§5
1099.
§5
1100.
§5
1101.
§5
1102.
§5
1103.
§5
104.
§5
1104.1
§5
1105.
§5
106.
§5
1107.
§5
1108.
§5
1109.
§5
no.
§5
no.i
§5
110.2
§5
110.3
§5
110.4
§51
111.
§5
112.
Right to a Reconsideration.
Request for Reconsideration.
Reconsidered Determination.
Right to Full Evidentiary Hearing.
Request for a Full Evidentiary
Hearing.
Full Evidentiary Hearing.
Termination of a Provider.
Remedies Other Than Termination.
Definitions 403
Health Care Financing
Administration's Common
Procedure Coding System.
Provider.
Blood Bank.
Physician.
Physicians' Services.
Emergency Services.
Experimental Services.
Unlabeled Use of Drugs.
Dentist.
Dental Services.
Dental School Clinic.
Emergency Dental Services.
Diagnostic Dental Services.
Restorative Dental Services.
Orthodontic Dental Services.
Registered Nurse.
Licensed Vocational Nurse.
Psychiatric Technician.
Chiiopractor.
Chiropractic Services.
Acupuncturist.
Acupuncture Services.
Podiatrist.
Podiatry Services.
Physical Therapist.
Physical Therapy.
Respiratory Care Practitioner.
Respiratory Care Practitioner
Services.
Occupational Therapist.
Occupational Therapy.
Dietitian.
Dietitian's Services.
Dispensing Optician.
Optometrist.
Optometric Services.
Hearing Aid Dispenser.
Hearing Aid.
Speech Pathologist.
Speech Pathology Services.
Audiologist.
Audiological Services.
Sign Language Interpreter Services.
Psychologist.
Psychologist Services.
Orthotist.
Ocularist.
Prosthetist.
Durable Medical Equipment and
Medical Supply Providers.
Incontinence Medical Supply
Dealer.
Pharmacist.
Pharmacy.
Pharmaceutical Services.
Inpatient.
Hospital.
Hospital Acute Care.
Hospital Extended Care.
Hospital Long-Term Care.
Hospital Extended Care Facility.
Hospital Intermediate Care.
Inpatient Hospital Services.
Hospital Outpatient Department.
§51113.
Hospital Outpatient Department
Services.
§51115.
Organized Outpatient Clinic.
§51115.1.
Organized Outpatient Clinic
Services.
§51115.5.
Rural Health Clinic.
§51115.6.
Rural Health Clinic Services.
§51115.7.
Rural Shortage Area.
§51116.
Outpatient Heroin Detoxification
Services.
§51117.
Rehabilitation Center.
§51118.
Intermediate Care Facility.
§51119.
Rehabilitation Services.
§51120.
Intermediate Care Services.
§51120.5.
Nursing Facility.
§51121.
Skilled Nursing Facility Services.
§51123.
Skilled Nursing Facility Services.
§51124.
Skilled Nursing Facility Level of
Care.
§51124.1.
Transitional Inpatient Level of Care.
§51124.2.
Medi-Cal Care Coordinator.
§51124.5.
Subacute Level of Care.
§51124.6.
Pediatric Subacute Care Services.
§51124.7.
Preceptorship.
§51125.
Home Health Agency.
§51127.
Coordinated Home Care.
§51128.
Specialized Rehabilitative Services
in Skilled Nursing Facilities or
Intermediate Care Facilities.
§51129.
Home Health Agency Services.
§51131.
Home Nursing Services.
§51132.
Short-Doyle Medi-Cal Providers.
§51133.
Home Health Aide Services.
§51134.
Short-Doyle Medi-Cal Provider
Services.
§51135.
Healing by Prayer or Spiritual
Means.
§51136.
Christian Science Facility.
§51137.
Laboratory.
§51137.1.
Clinical Laboratory or Laboratory.
§51137.2.
Clinical Laboratory or Laboratory
Services.
§51139.
Radiological and Radioisotope
Services.
§51141.
Outpatient Services.
§51142.
Inpatient Services.
§51143.
Outpatient Services.
§51145.
Home.
§51145.1.
"Home" Defined for the Personal
Care Services Program.
§51146.
Homebound Patient.
§51147.
Medical Social Work or Medical
Social Services.
§51149.
Social Work Services.
§51151.
Medical Transportation Services.
§51151.1.
Ambulance.
§51151.2.
Ambulance Patient.
§51151.3.
Litter Van.
§51151.4.
Litter Van Patient.
§51151.5.
Wheelchair Van.
§51151.6.
Wheelchair Van Patient.
§51151.7.
Nonemergency Medical
Transportation.
§51152.
Provider of Medical Transportation.
§51153.
Other Medically Indicated
Transportation Service.
§51154.
Renal Dialysis Center.
§51155.
Community Hemodialysis Unit.
§51156.
Renal Homotransplantation Center.
§51157.
Renal Dialysis, Renal
Homotransplantation and Related
Services.
§51158.
Nurse Anesthetist.
§51159.
Utilization Controls.
§51159.1.
Peer Review.
§51160.
Durable Medical Equipment.
§51161.
Prosthetic and Orthotic Appliances.
Page
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Title 22
Health Care Services
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Page
Page
§51162.
Eyeglasses, Prosthetic Eyes, and
Other Eye Appliances.
§51162.1.
Fabricating Optical Laboratory.
§51163.
Human Reproductive Sterilization.
§ 51164.
Intermediate Care Facility for the
Developmentally Disabled.
§51164.1.
Intermediate Care Facility for the
Developmentally Disabled
Habilitative.
§51164.2.
Intermediate Care Facility for the
Developmentally
Disabled-Nursing.
§51165.
Intermediate Care Facility Services
for the Developmentally Disabled.
§51165.1.
Intermediate Care Facility Services
for the Developmentally Disabled
Habilitative.
§51165.2.
Intermediate Care Facility Services
for the Developmentally
Disabled — Nursing.
§51170.
Nonphysician Medical Practitioner.
§51170.1.
Physician's Assistant.
§51170.2.
Nurse Midwife.
§51170.3.
Nurse Practitioner.
§51170.5.
Primaiy Care.
§51171.
Physician-Practitioner Interface.
§51172.
Date of Service.
§51173.
Acute Administrative Days.
§51173.1.
In-Home Medical Care and Nursing
Facility Waiver Services.
§51174.
Paramedic Ambulance Services.
§51175.
Nurse Midwife Services.
§51176.
Home and Community-Based
Waiver Services.
§51177.
Swing Bed Services.
§51178.
Swing Bed Facility.
§51179.
Comprehensive Perinatal Services.
§51179.1.
Comprehensive Perinatal Provider.
§51179.2.
Comprehensive Perinatal Nutrition
Services.
§51179.3.
Comprehensive Perinatal
Psychosocial Services.
§51179.4.
Comprehensive Perinatal Health
Education Services.
§51179.5.
Personal Supervision.
§ 51179.6.
Case Coordination.
§51179.7.
Comprehensive Perinatal
Practitioner.
§51179.8.
Individualized Care Plan.
§51179.9.
Protocol.
§51179.10.
Protocol.
§51180.
Hospice Care.
§51180.1.
Hospice.
§51180.2.
Terminally III.
§51180.3.
Routine Home Care.
§51180.4.
Continuous Home Care.
§51180.5.
Respite Care.
§51180.6.
General Inpatient Care.
§51180.7.
Representative.
§51181.
Personal Care Services Provider.
§51182.
Personal Representative.
§51183.
Personal Care Services.
§51184.
Early and Periodic Screening,
Diagnosis, and Treatment (EPSDT)
Program Definitions.
§51185.
Targeted Case Management
Services Program Definitions.
§51187.
Tuberculosis (TB) Infection.
§51187.1.
Tuberculosis (TB) Related Services.
§51190.1.
Local Educational Agency (LEA)
Eligible Beneficiary.
§51190.2.
Local Educational Agency (LEA)
Provider.
§51190.3.
Local Educational Agency (LEA)
Practitioner.
§51190.4.
Local Educational Agency (LEA)
Services.
§51190.5.
Managed Care Plan.
§5]]9].
Licensed Midwife.
§51192.
Licensed Midwife Services.
Article 3.
Standards for Participation 424
§51200.
Basic Requirement for Program
Participation.
§51200.01.
Established Place of Business.
§51201.
Physical Therapy.
§51201.1.
Physical Therapist.
§ 51202.
Speech Pathologist.
§51202.5.
Sign Language Interpreters.
§51203.
Occupational Therapy.
§51203.1.
Occupational Therapist.
§ 51204.
Personal Care Services Provider.
§51205.
Prosthetic and Orthotic Appliance
Facilities.
§51206.
Hospitals, Home Health Agencies
and Laboratories.
§51207.
Hospitals.
§51208.
Dispensing Optician.
§51208.1.
Fabricating Optical Laboratory.
§51209.
Hospital Outpatient Department.
§51210.
Blood Banks.
§51211.
Other Organized Outpatient
Services.
§51211.1.
Organized Outpatient Clinic.
§51211.2.
Laboratory or Clinical Laboratory.
§51211.5.
Rural Health Clinic Standards for
Participation.
§51212.
Intermediate Care Facility.
§51213.
Rehabilitation Center.
§51214.
Hearing Aid Dispenser.
§51215.
Skilled Nursing Facilities.
§51215.4.
Transitional Inpatient Care Unit.
§ 51215.5.
Subacute Care Unit.
§ 51215.6.
Participation Requirements for the
Adult Subacute Program and
Pediatric Subacute Program.
§ 51215.7.
Application for Subacute Care
Contract.
§51215.8.
Pediatric Subacute Care Unit.
§ 51215.9.
Pediatric Subacute Care
Unit — Physician Services.
§51215.10.
Pediatric Subacute Care
Unit — Rehabilitation Therapy
Services.
§51215.11.
Pediatric Subacute Care
Unit — Ventilator Weaning.
§51216.
Transfer of Ownership.
§51217.
Home Health Agency.
§51218.
Renal Dialysis Centers, Corrmiunity
Hemodialysis Units and Renal
Homotransplantation Centers.
§51219.
Audiologist.
§ 51220.
Chiropractor.
§ 51220.5.
Acupuncturist.
§51221.
Christian Science Facilities.
§ 51222.
Christian Science Practitioner.
§51223.
Dentist.
§51224.
Dental School Clinic.
§ 51224.5.
Durable Medical Equipment and
Medical Supply Providers.
§ 51225.
Orthotist.
§ 51225.5.
Respiratory Care Practitioner.
§51226.
Pharmacy.
§51227.
Pharmacist.
§ 51228.
Physician.
§ 51229.
Podiatrist.
§51230.
Prosthetist.
§51231.
Ambulance Requirements.
§51231.1.
Litter Van Requirements.
§51231.2.
Wheelchair Van Requirements.
§ 51232.
Psychologist.
§ 51233.
Optometrist.
§ 51234.
Psychiatric Technician.
§51235.
Dietitian.
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Title 22
Page
Page
§ 51236. Radiological and Radioisotope
Services.
§ 51237. Nurse Anesthetist.
§ 51238. Short-Doyle Medi-Cal Provider.
§ 51239. Outpatient Heroin Detoxification
Provider.
§ 51240. Utilization of Nonphysician Medical
Practitioners.
§ 51241. Physician Relationship to
Nonphysician Medical
Practitioners.
§ 51242. EPSDT Diagnosis and Treatment
Provider and EPSDT Supplemental
Services Provider.
§ 51242.1. EPSDT Supplemental Services
Provider — Pediatric Day Health
Care Facility.
§ 51243. Intermediate Care Facility for the
Developmentally Disabled.
§ 5 1 243. 1 . Intermediate Care Facility for the
Developmentally Disabled
Habilitative.
§ 5 1243.2. Intermediate Care Facility for the
Developmentally
Disabled-Nursing.
§ 51244. In-Home Medical Care Waiver
Services Provider and Nursing
Facility Waiver Services Provider.
§51245. Nurse Midwife.
§ 51246. Home and Cormnunity-Based
Waiver Services Providers.
§51247. Swing Bed Facility.
§51248. Ocularist.
§ 51249. Application Process for
Comprehensive Perinatal Providers.
§ 51250. Hospice.
§51251. Medical Device Retailer.
§ 51255. Licensed Midwife.
§ 51260. Certified Nurse Practitioner.
§ 51270. Local Educational Agency (LEA)
Provider.
§51271. Targeted Case Management
Services Provider Qualifications.
§ 51272. Targeted Case Manager.
§51273. Targeted Case Management
Advisory Committee.
§ 51276. Directly Observed Therapy (DOT)
Provider Qualifications.
Article 4. Scope and Duration of
Benefits 436.3
§51301.
Schedule of Benefits.
§ 51303.
General Provisions.
§51304.
Benefit Liinitations.
§ 51305.
Physician Services.
§51305.1.
Criteria for the Performance of
Sterilization.
§ 51305.2.
Requirements for Sterilization Other
Than Emergency Sterilization.
§ 51305.3.
Informed Consent Process for
Sterilization.
§51305.4.
Certification of Informed Consent
for Sterilization.
§ 51305.5.
Additional Requirements for
Informed Consent Process for
Elective Sterilization.
§ 51305.6.
Hysterectomy.
§51305.7.
Noncompliance.
§ 51305.8.
Effective Date.
§ 51305.9.
Interim Coverage of Intermediate
and Comprehensive
Ophthalmological Services for
Nonaphakic Beneficiaries.
§ 51306.
Optometry Services.
§51306.1.
Interim Coverage of Optometric
Services for Nonaphakic
Beneficiaries over 21.
§ 51307.
Dental Services. [Repealed]
§51308.
Chiropractic Services.
§ 51308.5.
Acupuncture Services.
§51309.
Psychology, Physical Therapy,
Occupational Therapy, Speech
Pathology and Audiological
Services.
§ 51309.5.
Sign Language Interpreter Services.
§51310.
Podiatry Services.
§51311.
Laboratory, Radiological and
Radioisotope Services.
§51312.
Prayer or Spiritual Healing.
§51313.
Pharmaceutical Services and
Prescribed Drugs.
§51313.3.
Limitations on Coverage of Drugs
on the Medi-Cal List of Contract
Drugs.
§51313.6.
Drug Evaluafion Criteria.
§51314.
Rehabilitation Center Outpatient
Services.
§51315.
Prosthetic and Orthotic Appliances.
§51316.
Respiratory Care Services.
§51317.
Eyeglasses, Contact Lenses, Low
Vision Aids, Prosthetic Eyes and
Other Eye Appliances.
§51317.1.
Interim Coverage of Eyeglass
Lenses.
§51319.
Hearing Aids.
§ 51320.
Medical Supplies.
§51321.
Durable Medical Equipment.
§ 51323.
Medical Transportation Services.
§51325.
Blood and Blood Derivatives.
§ 51326.
Nurse Anesthetist Services.
§51327.
Inpatient Hospital Services.
§ 51328.
Outpatient Heroin Detoxification
Services.
§ 51329.
Rehabilitation Center Services.
§ 51330.
Chronic Hemodialysis.
§51330.1.
Renal Homotransplantation.
§51331.
Hospital Outpatient Department
Services and Organized Outpatient
Clinic Services.
§51331.5.
Rural Health Clinic Services.
§ 51332.
Organized Outpatient Clinic
Services.
§ 51333.
Other Organized Outpatient
Services.
§51334.
Intermediate Care Services.
§51335.
Skilled Nursing Facility Services.
§ 51335.1.
Transitional Inpatient Care Services.
§51335.5.
Subacute Care Services.
§ 51335.6.
Pediatric Subacute Care Services.
§ 51336.
Specialized Rehabilitative Services
in Skilled Nursing Facilities and
Intermediate Care Facilities.
§ 51337.
Home Health Agency Services.
§51338.
Home Health Aide Services.
§51339.
Special Duty Nursing.
§ 51340.
Early and Periodic Screening,
Diagnosis, and Treatment (EPSDT)
Services and EPSDT Supplemental
Services.
§51340.1.
Requirements Applicable to EPSDT
Supplemental Services.
§51341.
Short-Doyle Mental Health
Medi-Cal Program Services.
§51341.1.
Drug Medi-Cal Substance Abuse
Services.
§ 51342.
Acute Administrative Days.
§ 51343.
Intermediate Care Facility Services
for the Developmentally Disabled.
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Health Care Services
Table of Contents
Page
Page
§51343.1.
§51343.2.
§ 51344.
§ 51345.
§51345.1.
§ 51346.
Intermediate Care Facility Services
for the Developmentally Disabled
Habilitative.
Intermediate Care Facility Services
for the Developmentally
Disabled-Nursing.
In-Home Medical Care Waiver
Services and Nursing Facility
Waiver Services.
Nurse Midwife Services.
Certified Family Nurse Practitioner
and Certified Pediatric Nurse
Practitioner Services.
Home and Community-Based
Waiver Services.
§51347.
Swing Bed Services.
§ 51348.
Comprehensive Perinatal Services.
§51348.1.
Comprehensive Perinatal Standards
of Care.
§51348.2.
Patient Rights.
§ 51349.
Hospice Care.
§ 51350.
Personal Care Services.
§51351.
Targeted Case Management
Services.
§51351.1.
Targeted Case Management
Provider Contracts.
§ 51355.
Tuberculosis (TB) Related Services.
§ 51356.
Licensed Midwife Services.
§ 51360.
Local Educational Agency (LEA)
Services.
§ 51365.
Targeted Case Management
Services Program.
Article 5.
Scope and Duration of
Supplemental Schedule of
Benefits 466.1
§51401.
Medically Needy Benefits.
§ 51403.
General Provisions.
§ 51405.
Physicians' Services.
§ 51406.
Nursing Home and Convalescent
Home Services.
§ 51407.
Blood and Blood Derivatives.
§ 51409.
Physical Therapy Services.
§51410.
Podiatrists' Services.
§ 51413.
Prescribed Drugs.
§ 51427.
Inpatient Hospital Services.
Article 6.
Eligibility for Payment 466.1
§51451.
Inclusions, Exclusions and
Suspensions.
§ 51452.
Violation of Regulations,
Administrative Sanctions.
§ 51453.
Recommendation for Suspension.
§ 51454.
Provider Defined.
§ 51454.1.
Provider of Personal Care Services
Defined.
§ 51455.
Prior Authorization.
§ 51456.
Signing Treatment Authorization
Requests.
§ 51457.
Administrative Action.
§ 51458.
Cause for Suspension.
§51458.1.
Cause for Recovery of Provider
Overpayments.
§ 51458.2.
Statistical Extrapolation of
Medi-Cal Provider Reviews.
§ 51459.
Reinstatement.
§ 51460.
Special Claims Review.
§ 51461.
Orders for Suspension or Placement
on Prior Authorization.
§ 51463.
Requests for Hearing.
§ 51464.
When Hearing Not Requested.
§ 51465.
Review by the Director.
§ 51466.
Disclosure of Significant Beneficial
Interest.
^51466.1.
Significant Beneficial Interest.
§ 51467.
Advertising.
§ 51469.
Decertificafion.
§ 51470. Billing for Benefits Provided.
§ 51471 . Seeking Reimbursement from
Beneficiaries.
§ 51471.1. Reimbursements for Program
Underpayments.
§51472. Sub-Standard Services.
§51473. Excessive Services.
§ 51473.1 . Referral for Excessive Services.
§ 5 1 473.2. Services to Children.
§51474. False Advertising.
§ 51475. Refusal to Render Services.
§ 51476. Keeping and Availability of
Records.
§ 51476.1. Pharmacy and Clinic with Special
Permit Records of Pharmaceutical
Services.
§ 51476.2. Personal Care Services Records.
§ 51477. Confidential Beneficiary
Information.
§ 51478. Prohibition of Rebate, Refund, or
Discount.
§ 51479. Change of Order or Prescripfion.
§ 51480. Discriminatory Billings.
§ 5 1 48 1 . Forbidden Conduct.
§ 51482. Unwarranted Inpatient Discharge.
§51483. Provider Requirements.
§ 51483.1. Personal Care Provider
Requirements.
§ 51484. Billing for Suspended Provider.
§ 51485. Submission of False Information.
§ 51485.1 . Civil Money Penalties.
§ 51486. Medi-Cal Card Labels.
§ 51487. Examinafions of Beneficiaries.
§51488. Pharmaceutical
Postservice — Postpayment On-Site
Reviews Including Clinics with
Special Permits.
§ 51488.1. Pharmaceufical Recovery Standards
Including Clinics with Special
Permits.
§ 51488.2. Stadstical Extrapolafion for
Medi-Cal Pharmacy Reviews.
§ 51488.3. Underpayment Adjustments to
Medi-Cal Reviews of Pharmacies
and Clinics with Special Permits.
§51488.4. Adjustments to Medi-Cal Pharmacy
and Clinic with a Special Permit
Reviews for Unsubmitted Claims.
§51489.
Eligibility for Payment for
Paramedic Ambulance Services.
§ 51490.
Claim Submission Requirements for
Short-Doyle Medi-Cal Providers.
§51490.1.
Claim Submission Requirements for
Counties and Providers of Drug
Medi-Cal Substance Abuse
Services.
§ 51491.
Local Educational Agency (LEA)
Eligibility for Payment.
§51492.
Claim Submission Requirements for
Targeted Case Management
Providers.
§51492.1.
Host County Contractual
Responsibilifies in the Targeted
Case Management Program.
§ 51492.2.
Participation Fee Requirements in
the Targeted Case Management
Program.
Article 7.
Payment for Services and
Supplies 471
§51501.
General.
§ 51502.
Billing Requirements.
§51502.1.
Requirements for Electronic Claims
Submission.
§ 51503.
Physician Services.
Page xi
(7-18-2008)
Table of Contents
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
Page
Page
§51503.1.
Reimbursement for Services
Rendered by a Nonphysician
Medical Practitioner.
§51503.2.
Reimbursement for Services
Rendered by a Nurse Midwife, a
Certified Family Nurse Practitioner,
or a Certified Pediatric Nurse
Practitioner.
§51503.3.
Reimbursement for Sign Language
Interpreter Services.
§51504.
Comprehensive Perinatal Services.
§51504.1.
Reimbursement for Services
Rendered by a Licensed Midwife.
§51505.
Other Professional Services.
§51505.1.
Podiatry Services.
§51505.2.
Nurse Anesthetist Services.
§ 51505.3.
Psychology Services.
§ 51506.
Dental Services.
§51506.1.
Maxillofacial Dental Services.
§ 51506.2.
Orthodontic Dental Services.
[Repealed]
§51507.
Physical Therapy.
§51507.1.
Occupational Therapy.
§51507.2.
Speech Therapy and Audiology.
§ 51507.3.
Respiratory Care Practitioner.
§51508.
Hospital Inpatient Services
Reimbursement.
§51508.1.
Extraordinary Administrative
Adjustments.
§51508.2.
Definitions.
§51508.3.
Application.
§51508.4.
Review of Application.
§ 51508.5.
Criteria for Review.
§51508.6.
Recommendation .
§51508.7.
Action by the Director.
§51508.8.
Conditional Administrative
Adjustments.
§51508.9.
Medi-Cal Hospital Payment Rate
Exception.
§ 51509.
Hospital Outpatient Departments.
§51509.1.
Organized Outpatient Clinics.
§ 51509.2.
Chronic Hemodialysis Services.
§51509.3.
Rural Health Clinic
Reimbursement.
§51510.
Nursing Facility Level A Services.
§51510.1.
Intermediate Care Services for the
Developmentally Disabled.
§ 51510.2.
Intermediate Care Services for the
Developmentally
Disabled-Habilitative.
§51510.3.
Intermediate Care Services for the
Developmentally
Disabled-Nursing.
§51511.
Nursing Facility Level B Services.
§51511.1.
Special Program Services for the
Mentally Disordered.
§51511.2.
Uniform Accounting and Cost
Reporting System for Skilled
Nursing Facilities and Intermediate
Care Facilities.
§51511.3.
Transitional Inpatient Care Services
Reimbursement.
§51511.5.
Nursing Facility
Services — Subacute Care
Reimbursement.
§51511.6.
Nursing Facility Services — Pediatric
Subacute Care Reimbursement.
§51512.
Certified Outpatient Rehabilitation
Centers.
§51513.
Pharmaceutical Services and
Prescribed Drugs.
§51513.1.
Average Wholesale Price (AWP).
§51513.2.
Establishment of Maximum
Allowable Ingredient Cost.
§51513.3.
Maximum Allowable Ingredient
Cost.
§51513.4.
Maximum Allowable Cost.
§51513.5.
Estimated Acquisition Cost.
§51513.6.
Prudent Purchase of Drugs
Program.
§51514.
Chiropractic Services.
§51514.5.
Acupuncture Services.
§51515.
Reimbursement for Prosthetic and
Orthotic Appliances and Repairs.
§51516.
Reimbursement for
Short-Doyle/Medi-Cal Services.
§51516.1.
Reimbursement Rates for Drug
Medi-Cal Substance Abuse
Program Services.
§51517.
Hearing Aids.
§51518.
Optometry Services.
§51519.
Eye Appliances.
§51519.1.
Dispensing Fees for Ophthalmic
Appliances Supplied by a
Fabricating Optical Laboratory
Under an Exclusive Area Negotiated
Contract,
§51519.2.
Reimbursement Rates for
Ophthalmic Appliances Supplied by
a Fabricating Optical Laboratory
Under an Exclusive Area Negotiated
Contract.
§51520.
Medical Supplies.
§51520.1.
Establishment of Maximum
Allowable Product Cost for Medical
Supplies.
§51520.2.
List of Generic Medical Supply
Types.
§51521.
Durable Medical Equipment.
§51522.
Hearing and Speech Centers.
§51523.
Home Health Agency Services.
§ 51524.
in-Home Medical Care Waiver
Services and Nursing Facility
Waiver Services.
§51525.
Blood and Blood Derivatives.
§ 51526.
Incontinence Medical Supplies.
§51527.
Medical Transportation Services.
§51528.
Paramedic Ambulance Services.
§51529.
Pathology Services.
§51531.
X-Ray Services.
§51532.
Early and Periodic Screening,
Diagnosis, and Treatment (EPSDT)
Services.
§51532.1.
Early and Periodic Screening,
Diagnosis and Treatment (EPSDT)
Supplemental Services Provided by
Registered Nurses, Licensed
Vocational Nurses and Certified
Home Health Aides.
§51532.2.
Early and Periodic, Screening,
Diagnosis, and Treatment (EPSDT)
Supplemental Services: Onsite
Investigation to Detect the Source of
Lead Contamination.
§51532.3.
EPSDT Supplemental Services
Provider — Pediatric Day Health
Care Facility Reimbursement.
§51533.
Outpatient Heroin Detoxification
Services.
§51534.
Home and Community-Based
Services.
§51535.
Leave of Absence.
§51535.1.
Bed Hold for Acute Hospitalization.
§51535.2.
Reimbursement Rates for Personal
Care Services Program.
§ 51535.5.
Local Educational Agency (LEA)
Services.
§51535.6.
Reimbursement for Directly
Observed Therapy (DOT).
§51535.7.
Targeted Case Management
Services Reimbursement.
Page
XII
(7-18-2008)
Title 22
Health Care Services
Table of Contents
Page
Page
Article 7.5.
Hospital Inpatient Services
§53121.
Medi-Cal Beneficiary.
Reimbursement Section 516.4(d)(7)
§ 53122.
§ 53124.
Member.
Prepaid Health Plan.
§51536.
Hospital Inpatient Services
§ 53126.
Prepaid Patient Population.
Reimbursement.
§ 53128.
Preventive Health Care.
§ 51537.
Maximum Allowable
§ 53130.
Primary Care Physician.
Reimbursement Level for Inpatient
§53132.
Public Hearing.
Hospital Services.
§ 53133.
Risk Limit.
§ 51538.
Maximum Allowable Rate of
§ 53134.
Service Area.
Increase for Inpatient Hospital
§53136.
Service Location.
Services.
§53138.
Service Site.
§51539.
Hospital Reimbursement for
§53140.
State Employee.
Inpatient Hospital Services.
§53142.
State Officer.
§51540.
Hospitals with a Disproportionate
§ 53144.
Subcontract.
Share of Low Income Patients.
§53144.5.
Sub-Subcontract.
§51541.
Hospital Inpatient Services
§ 53145.
Substantial Financial Interest.
Reimbursement.
§53150.
Unit Medical Record.
§51542.
Acute Administrative Days.
§53152.
Vendor.
§51543.
Out-of-State Hospital Inpatient
Services Reimbursement.
Article 3.
Operational Requirements 520
§ 51544.
Hospice Care.
§ 53200.
Organization and Administration.
§51545.
Definitions.
§ 53210.
Scope of Services.
§ 51546.
Reimbursement Limits.
§ 53212.
Availability of Services.
§51547.
Methods of Payment.
§ 53214.
Pharmaceutical Services and
§ 51548.
Overpayments.
Prescribed Drugs.
§51549.
Reimbursement Formula.
§ 53216.
Care Under Emergency
§51550.
Administrative Adjustment Process.
Circumstances.
§51551.
Specific Administrative Adjustment
§ 53218.
Preventive Health Care Services.
Issues.
§ 53220.
Member Billing.
§51552.
AA Formal Appeals Process.
§ 53222.
Recovery from Other Sources.
§ 51553.
Peer Grouping.
§ 53230.
Facilities, Service Locations and
§ 51554.
Peer Group Administrative
Equipment.
Adjustments.
§ 53240.
Personnel Resources.
§ 51555.
Peer Group Specific Administrative
§ 53242.
Providers.
Adjustment Issue.
§ 53244.
Allied Health Personnel.
§ 51556.
Contracts.
§ 53246.
Medical Director.
§ 51557.
Disproportionate Share.
§ 53250.
Subcontracts.
Article 8.
Conflict of Interest 516.19
§53251.
§ 53252.
Assumption of Financial Risk.
Reinsurance.
§51600.
Definitions.
§ 53260.
Grievance Procedures.
§51601.
Exclusion from Proceedings.
§53261.
Notice to Meinbers of Plan Action
§ 51602.
Prohibition Against Contracting.
to Deny, Defer or Modify a Request
Article 10.
Early and Periodic
for Medical Services.
§ 53270.
Consumer Participation in Policy
Screening, Diagnosis, and
Making.
Treatment Program 517
§ 53280.
Quality of Care.
§ 53282.
Medical Record System.
Chapter 3.5.
Pilot and Demonstration
§ 53284.
§ 53286.
Medical Record Service.
Continuity of Care.
Projects 517
§ 53288.
Shared Responsibility for Members'
Health Care.
Chapter 4.
Prepaid Health Plans 517
§ 53290.
Medical Review.
§53291.
General Reviews.
Article 1.
General Provisions 517
§ 53310.
§ 53312.
Records.
§ 53000.
General.
Reporting.
§ 53314.
Statistical Data.
Article 2.
Definitions 517
§ 53320.
§53321.
Capitation Payment.
Capitation Payment Rates
§53100.
Acceptable Medical Care.
§53101.
Actuarial Equivalence.
Determination.
§53101.1,
Actuarial Method.
§ 53322.
Capitation Rate Redetermination.
§53102.
Affiliate.
§ 53323.
Cost Reimbursement.
§53104.
Carrier.
§ 53324.
Financial Resources.
§ 53106.
Catastrophic Coverage Limitation.
§ 53326.
Financial Security.
§ 53108.
Contract.
§ 53330.
Affiliate.
§53110.
Control.
§ 53340.
Financial Audit.
§53111.
Department.
§ 53350.
Civil Penalties.
§53112.
Director.
§ 53352.
Contract Termination.
§53114.
§53115.
Disenrollment.
Door-to-Door Marketing.
Article 4.
Marketing, Enrollment and
§53115.5.
Effective Date of Enrollment.
Disenrollment 528
§53116.
Enrollment.
§ 53400.
Marketing.
§53116.5.
Experience Data.
§53401.
Marketing on County Premises.
§53117.
Facility.
§53401.1.
Marketing on State Premises.
§53117.3,
Formal Grievance.
§ 53402.
Marketing Representatives.
§53117.7.
Immediate Family.
§ 53404.
Marketing Presentation.
§53117.9.
Informal Grievance.
§ 53406.
Misrepresentation.
§53118.
Marketing.
§ 53407.
Door-to-Door Marketing.
§ 53120.
Marketing Representative.
§ 53408.
Prepaid Patient Population.
Page xiii
(7-18-2008)
Table of Contents
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
§ 53420.
§ 53422.
§ 53424.
§ 53426.
§ 53440.
§ 53442.
§ 53450.
§ 53452.
S 53454.
§ 53456.
§ 53458.
Article 5.
Page
Member Enrollment.
Enrollment Application.
Enrollment Application Processing.
Term of Membership.
Disenrollmenl of Members.
Discnrollment Requests.
Information to New Enrollees.
Information to New Members.
Annual Information to Members.
Notification of Changes in Services.
Information for Departmental
Dissemination.
Applications, Contracts and
Public Hearings 530
S 53500.
Application Information.
S 53502.
Rejection of Contract Applications.
§ 53504.
Effect and Term of Contracts.
§ 53506.
Contract Renewals.
§ 53508.
Mergers or Reorganizations.
^53510.
Reorganizations and Intraplan
Mergers.
§53518.
Prehearing Requirements.
§ 53520.
Public Notice and Public Healings.
$ 53522.
Public Hearing Process.
Article 6.
Conflict of Interest 532
§ 53600.
Prohibitions Against Contracting.
§53601.
Disclosure Statements.
Article 7.
Emergency Services Claims
Disputes 532
§ 53620.
General Provisions.
§ 53622.
Definitions.
§ 53624.
Claims Filing.
§ 53626.
Fihng and Service.
§ 53628.
Claim Content.
§ 53630.
Dismissal After Notice of Defective
Claim.
§ 53632.
Notice of Defense.
§ 53634.
Defaults.
§ 53636.
Amended or Supplemental Claims.
§ 53638.
Consolidation of Claims.
§ 53640.
Additional Parties.
§ 53642.
Withdrawal or Settlement of Claim.
§ 53644.
Discovery.
§ 53646.
Submissions.
§ 53648.
Nondisclosure.
§ 53650.
Expedited or Deferred Proceedings.
§ 53651.
Small Claims Procedure.
§ 53652.
Request for Hearing.
§ 53654.
Decision on Written Record.
§ 53656.
Prehearing and Posthearing
Conferences.
§ 53658.
Notice of Hearing.
§ 53660.
Time and Place of Hearing.
§ 53662.
Witnesses and Subpoenas.
§ 53664.
Depositions.
§ 53666.
Hearing Officer.
§ 53668.
Medical Consultant.
§ 53670.
Evidence Rules.
§ 53672.
Affidavits As Evidence.
§ 53674.
Official Notice.
§ 53676.
Hearing Procedure.
§ 53678.
Record of Hearing.
§ 53680.
Joint Hearings.
§ 53682.
Severance of Issues.
§ 53684.
Oral and Written Argument.
§ 53686.
Confinued Hearings.
§ 53688.
Additional Evidence.
§ 53690.
Burden of Proof
§53691.
Decisions by the Hearing Officer.
§ 53692.
Decision.
§ 53694.
Reconsideration.
§ 53696.
Relief from Decision or Order.
§ 53697.
Judicial Review.
§ 53698.
Standard of Liability.
Page
§ 53700. Liquidation of Liability.
§ 53702. Liability Offset.
Chapter 4. 1 . Two-Plan Model Managed Care
Program 538
Article 1. General Provisions 538
§ 53800. General Provisions.
Article 2. Definitions 538
§53810. Definitions.
Article 3. Maximum Enrollment Levels .... 538.2
§ 53820. Maximum Enrollment Levels.
Article 4. Prepaid Health Plan and
Primary Care Case
Management Plan Enrollment
Growth During the
Transition Period 538.2
§ 53830. Prepaid Health Plan and Primary
Care Case Management Plan
Enrollment Growth During the
Transition Period.
Article 5. Two-Plan Model
Requirements 538.2(a)
§ 53840. Two-Plan Model Requirements.
§ 53845. Enrollment Criteria.
§ 53850. Organization and Administration.
Article 6. Operational Requirements 538.2(c)
§ 53851. Scope of Services.
§ 53852. Availability of Services.
§ 53853. Accessibility of Services.
§ 53854. Pharmaceutical Services and
Prescribed Drugs.
§ 53855. Care Under Emergency
Circumstances.
§ 53856. Facilities, Service Locafions, and
Equipment.
§ 53857. Medical Director.
§ 53858. Member Grievance Procedures.
§ 53859. Provider Grievances and
Complaints.
§53860. Quality of Care.
§53861. Records.
§ 53862. Reporting.
§ 53863. Assumption of Financial Risk.
§ 53864. Financial Standards/Resources.
§ 53865. Financial Performance Guarantee.
§ 53866. Member Billing and Recovery from
Other Sources.
§ 53867. Subcontracts.
§ 53868. Reinsurance.
§ 53869. Capitation Payment, Payment Rate
Determination/Redetermination.
§ 53870. Affiliated Organizations and
Persons.
§53871. Financial Audit.
§ 53872. Civil Penalties.
§ 53873. Contract Termination.
§ 53874. Conflict of Interest.
§ 53875. Emergency Services Claims
Disputes.
§ 53876. Cultural and Linguistic
Requirements.
Article 7. Marketing, Enrollment,
Assignment, and
DisenroUment 538.2(j)
§ 53880. Marketing.
§ 53881 . Marketing and Member Materials.
§ 53882. Member Enrollment.
§53883. Assignment of Eligible
Beneficiaries to Plans.
§ 53884. Assignment System.
Page xiv
(7-18-2008)
Title 22
Health Care Services
Table of Contents
Page
Page
§ 53885.
§ 53886.
§ 53887.
§ 53888.
§ 53889.
§ 53890.
§ 53890.5.
§ 53891.
§ 53892.
§ 53893.
§ 53894.
§ 53895.
§ 53896.
§ 53897.
§ 53898.
Travel Distance Standards.
Health Care Options Presentation.
Exemption from Plan Enrollment.
Enrollment/DisenroUment Form.
Enrollment/Disenrollment
Processing.
Assignment of Primary Care
Physician.
Assignment of a Primary Care
Provider.
Disenrollment of Members.
Problem Resolution Process for
Members.
Medi-Cal Managed Care
Ombudsman.
Notice to Members of Plan Action
to Deny, Defer or Modify a Request
for Medical Services.
Information to New Members.
Annual Information to Members.
Notification of Changes in Services.
Information for Departmental
Dissemination.
§ 53927.5. Notification of Changes in Services.
§ 53928. Information for Departmental
Dissemination.
Chapter 5.
Adult Day Health Care 538.10
Chapter 4.5. Geographic Managed Care
Program
Article 1.
§ 53900.
§ 53902.
§ 53904.
§ 53906.
Article 2.
§ 53910.
§ 53910.5.
§53911.
§53911.5.
§ 53912.
§ 53912.5.
§ 53913.
§53913.5.
§ 53914.
§ 53914.5.
§ 53915.
§ 53915.5.
§ 53916.
Article 3.
§ 53920.
§ 53920.5.
§ 53921.
§53921.5.
§ 53922.
§ 53922.5.
§ 53923.
§ 53923.5.
§ 53924.
§ 53924.5.
§ 53925.
§ 53925.5.
§ 53926.
§ 53926.5.
§ 53927.
538.2(r)
General Provisions 538.2(r)
General.
Definitions.
CMC Plan Requirements.
Eligible Beneficiaries.
Operational Requirements 538.3
Organization and Administration.
Scope of Services.
Availability of Services.
Accessibility to Physicians and
Dentists.
Pharmaceutical Services and
Prescribed Drugs.
Care Under Emergency
Circumstances.
Facilities, Service Locations and
Equipment.
Medical Director and Dental
Director.
Member Grievance Procedures.
Provider Grievances and
Complaints.
Quality of Care.
Records.
Reporting.
Marketing, Enrollment,
Assignment, and
Disenrollment 538.6
Marketing.
Marketing and Member Materials.
Member Enrollment.
Assignment of Eligible
Beneficiaries to GMC Plans.
Equitable Distribution.
Travel Distance Standards.
Options Presentation.
Alternative to GMC Plan
Enrollment.
Enrollment/Disenrollment Form.
Enrollment/Disenrollment Form
Processing.
Assignment of Primary Care
Provider.
Disenrollment of Members.
Problem Resolution Process for
Members.
Information to New Members.
Annual Information to Members.
Article I.
General Provisions 538.10
§54001.
General.
§ 54003.
Definitions and Standards.
§ 54005.
Grants.
Article 2.
Definitions 538.10
§54101.
Activity Program.
§ 54103.
Adult Day Health Care.
§54105.
Adult Day Health Center.
§ 54107.
Adult Day Health Care County
Plan.
§ 54108.
Adult Day Health Caie Planning
Council.
§ 54109.
Affiliate.
§54111.
Beneficiary Agreement of
Participation.
§54113.
Day of Attendance.
§54115.
Daily Rate.
§54117.
Discharge.
§54119.
Individualized Plan of Care.
§54121.
MuUidisciplinary Team.
§54123.
Nonmedical Transportation.
§ 54125.
Nutrition Service.
§ 54127.
Nursing Service.
§ 54129.
Occupational Therapy.
§54131.
Participant.
§54133.
Psychiatric and Psychological
Services.
§54135.
Service Area.
§ 54137.
Staff Physician Services.
§ 54139.
Subcontract.
§54141.
Supervision.
Article 3.
Eligibility, Participation
and Discharge 539
§54201.
Eligibility.
§ 54203.
Participation.
§ 54205.
Physician Request.
§ 54207.
MuUidisciplinary Team Assessment.
§ 54209.
Prior Authorization.
§54211.
MuUidisciplinary Team.
§54213.
Discharge.
§ 54215.
Reassessment.
§ 54217.
Beneficiary Agreement of
Participation.
§54221.
Hours of Operation.
§ 54223.
Attendance.
Article 4.
Services and Standards 541
§54301.
Certification.
§ 54303.
Denial of Initial Certification.
§ 54305.
Termination or Suspension of
Certification.
§ 54307.
Denial of Renewal of Certification.
§ 54309.
Required Services.
§54311.
Optional Services.
§ 54313.
Physical Therapy Service.
§ 54315.
Occupational Therapy Services.
§ 54317.
Speech Therapy Services.
§ 54319.
Staff Physician Services.
§54321.
Personal Physician.
§ 54323.
Nursing Service.
§ 54325.
Psychiatric and Psychological
Services.
§ 54327.
Personal Psychiatrist and
Psychologist Services.
§ 54329.
Medical Social Services.
§54331.
Nutrition Service.
§ 54333.
Transportation.
§ 54335.
Emergency Service.
§ 54337.
Program Aides.
§ 54339.
Activity Program.
Page XV
(7-18-2008)
Table of Contents
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
Page
Page
Article 5.
Administration
§54401.
Organization and Administration.
§ 54403.
Administrator.
§ 54405.
Program Director.
§ 54406.
Activity Coordinator.
§ 54407.
Grievance Procedure.
§ 54409.
Participant Fair Hearing.
§54411.
Reports.
§54413.
Financial Reporting.
§ 54415,
Medical Review.
§54417.
On-Site Visits.
§54419.
Utilization Review Conunittee.
§54421.
Advisory Comniittees.
§ 54423.
Staffing Requirements.
§ 54425.
Participant Records.
§ 54429.
Solicitation.
§54431.
Service Aiea.
§ 54433.
Subcontracts.
§ 54435.
Civil Rights of Participants.
§ 54437.
Civil Rights of Employees.
§ 54439.
Confidentiality of Data.
§ 54443.
Informational Material.
§ 54445.
Conflict of Interest.
§ 54447.
Provider Sanctions.
Article 6.
Payment of Services
§54501.
Adult Day Health Care Services.
§ 54503.
Fee Schedule.
§ 54504.
Transition Visits.
§ 54505.
Initial Assessment Rate.
§ 54507.
Billing Requirements.
546
551
Chapter 5.5. Indians and Indian Health
Service Facilities in Medi-Cal
Managed Care Programs 552
§ 55000. General.
§55100. Definitions.
§ 55110. Enrollment of Indians in Medi-Cal
Managed Care Plans.
§ 55120. Indian Health Service Facility
Participation in Medi-Cal Managed
Care Programs.
§ 55130. Indian Health Service Facilities as
Fee-for-Service Managed Care
Plans.
§ 55140. Indian Health Service Facility
Reimbursement When
Subcontracting with a Medi-Cal
Managed Care Plan.
§ 55150. Indian Health Service Facility
Out-of-Plan Reimbursement.
§ 55160. Indian Health Service Facility
Fee-for-Service Managed Care Plan
Reimbursement.
§ 55170. Indian Health Service Facilities and
Non-Indian Beneficiaries.
§ 55180. Indian Health Service FaciUties and
the Health Care Options Program.
Chapter 6. Primary Care Case Management
Plans 552.3
Article 1. General Provisions 552.3
§ 56000. General.
Article 2. Definitions 552.4
§ 56100. Acceptable Medical Care.
§ 56101. Actuarial Equivalence.
§ 56101.1. Actuarial Method.
§ 56102. Affiliate.
§ 56114. Disenrollment.
§ 561 1 5. Door-to-Door Marketing.
§ 56115.5. Effective Date of Enrollment.
§56116. Enrollment.
§ 56116.5. Experience Data.
§56117. Facility.
§56118.
Marketing.
§56120,
Marketing Representative.
§56122.
Member.
§56124.
Optional Services.
§56130.
PCCM Contract.
§56133,
Risk Limit.
§56138,
Service Site.
§56144.
Subcontract.
§56144.5.
Sub-Subcontract.
§56146.
Written Approval.
§ 561 52.
Vendor.
Article 3.
Operational Requirements 556
§ 56200.
Organization and Administration.
§56210.
Scope of Services.
§56212.
Availability of Services.
§56214.
Pharmaceutical Services and
Prescribed Drugs.
§56216.
Care Under Emergency
Circumstances.
§ 56220.
Member Billing.
§ 56222.
Recovery from Other Sources.
§ 56230.
Facilities and Service Sites.
§ 56242.
Providers.
§ 56246.
Medical Director.
§ 56250.
Subcontracts.
§56251.
Assumption of Financial Risk.
§ 56252.
Reinsurance.
§ 56260.
Grievance Procedures.
§56261.
Notice to Members of PCCM Plan
Action to Deny, Defer or Modify a
Request for Medical Services.
§ 56262.
Provider Grievance and Complaints.
§ 56264.
Member Complaints.
§ 56280.
Quality of Care.
§ 56284.
ConfidentiaUty of Medical Records.
§ 56286.
Continuity of Care.
§56310.
Records.
§ 56312.
Reporting.
§ 56314.
Statistical Data.
§ 56320.
Capitation Payment.
§56321.
Capitation Payment Rates
Determination.
§ 56322.
Capitation Rate Redetermination.
§56322.1.
Savings Sharing.
§ 56324.
Financial Resources.
§ 56326.
Financial Security.
§ 56330.
Affiliate.
§ 56340.
Financial Audit.
§ 56350.
Civil Penalties and Sanctions.
§ 56352.
Contract Termination.
Article 4.
Marketing, Enrollment and
Disenrollment 565
§ 56400.
Markefing.
§56401.
Door-to-Door Marketing.
§ 56402.
Marketing Representative.
§ 56404.
Markefing Presentation.
§ 56406.
Misrepresentation.
§ 56408.
Penalties for Misrepresentation.
§ 56420.
Member Enrollment.
§ 56424.
Designation Form Processing.
§ 56426.
Term of Membership.
§ 56440.
Disenrollment of Members.
§ 56442.
Disenrollment Requests.
§ 56450.
Informafion to Prospecfive
Members.
§ 56452.
Information to New Members.
§ 56456.
Nofificafion of Changes in Services.
Article 5.
Application and Proposal 568.1
§ 56500.
Application and Proposal
Information.
§ 56502.
PCCM Contract Selection Criteria.
§ 56505.
Contract Term.
§ 56506.
Contract Renewals.
§ 56508.
Mergers, Reorganizations or
Assumpfions.
Page
XVI
(7-18-2008)
Title 22
Health Care Services
Table of Contents
§ 56520.
Article 6.
§ 56600.
Public Notice.
Conflict of Interest . .
Conflict of Interest.
Chapter 7.
Article 1.
§ 57000.
S 57003.
§ 57006.
§ 57009.
§ 57012.
§ 57015.
§57018.
§57021.
§ 57024.
Article 2.
§ 57027.
§ 57030.
Article 3.
§ 57033.
§ 57036.
§ 57039.
Construction/Renovation
Reimbursement Program
Definitions
Capital Expenditure Project.
Debt Service.
Disproportionate Share Hospital.
Final Plans.
Fixed Equipment.
New Debt.
Revenue Bond.
Three Most Recent Years.
Supplemental Reimbursement.
Eligibility for Construction/
Renovation Reimbursement
Program
Hospital Eligibility.
Capital Expenditure Project
Certification.
f
Standards for Supplemental
Reimbursement
Page
568.3
568.4
568.4
Page
§ 58030. Qualified Official Designee of a
Care Management Provider Agency.
570
§58031.
Quarterly/Annually.
§ 58032.
Residential Care Facility.
§ 58033.
Respite Care.
§ 58034.
Service Summary.
§ 58035.
Severe Cognitive Impairment.
§ 58036.
Shortened Benefit Period
Nonforfeiture Benefit.
§ 58037.
Standby Assistance.
§ 58038.
Substanfial Supervision.
Article 2.
Conditions of Issuer
Participation 578
§ 58050.
Issuer Requirements.
§58051.
Targefing Requirements.
§ 58052.
Marketing and Disclosure
Requirements.
§ 58053.
Conversion of Policies or
Certificates.
§ 58054.
Conversion of Certified Policies and
Certificates to Non-Certified Status.
§ 58055.
Issuer's Liability.
§ 58056.
Agent Training.
§ 58057.
Termination of Issuer Participation.
§ 58058.
Conditions Governing
Discontinuance of Sales by the
Issuer.
570
Article 3.
Chapter 8.
Supplemental Reimbursement
Calculation.
Reimbursement Provisions.
Continuing Eligibility.
California Partnership for Long-
Term Care
Benefits and Provisions for
Partnership Policies and
Certificates
icle 1.
Definitions
§ 58000.
Activities of Daily Living.
§58001.
Adult Day Health/Social Care.
§ 58002.
Average Daily Private Pay Rate for
Nursing Facilities.
§ 58003.
Benefit Eligibility.
§ 58004.
California Partnership for
Long-Term Care.
§ 58005.
Care Management/Care
Coordination.
§ 58006.
Care Management Provider Agency.
§ 58007.
Care Management Supervisor.
§ 58008.
Care Manager/Coordinator.
§ 58009.
Certificate.
§ 58010.
Elimination Period.
§58011.
Formal Long-Term Care Services.
§ 58012.
Hands-On Assistance.
§ 58013.
Home Health Care Services.
§ 58014.
Elimination Period.
§ 58015.
Formal Long-Term Care Services.
§ 58016.
Home Health Care Services.
§ 58017.
Homemaker Services.
§58018.
Hospice Services.
§ 58019.
Informal Long-Term Care Services.
§ 58020.
Issuer.
§58021.
Licensed Health Care Practitioner.
§ 58022.
Long-Term Care Services
Countable Toward Medi-Cal
Property Exemption.
§ 58023.
Medi-Cal Asset Protection.
§ 58024.
Medi-Cal Property Exemption.
§ 58025.
Partnership Long-Term Care
Insurance Policy or Certificate, or
Partnership Policy or Certificate.
§ 58026.
Personal Care Services.
§ 58027.
Plan of Care.
§ 58028.
Policy.
§ 58029.
Qualified Long-Term Care
Services.
571
§ 58059.
§ 58060.
§58061.
§ 58062.
Required Benefits for Partnership
Policies and Certificates.
Required Provisions for Partnership
Policies and Certificates.
Required Provisions to Allow the
Increase or Decrease of Benefits in
Partnership Policies or Certificates.
Benefits and Provisions Allowable
in Partnership Policies or
Certificates.
584
§ 58063.
Prohibited Provisions in Partnership
Policies or Certificates.
§ 58064.
Information for Establishing
Allowable Benefits and Minimum
and Maximum Benefits.
Article 4.
Premium Provisions 589
§ 58065.
Basic Premium Provisions.
§ 58066.
Provisions Governing Premiums
When Benefits Increase or
Decrease.
§ 58067.
Provisions Governing Rate
Increases.
Article 5.
Care Management Provider
Agency Standards 590
§ 58068.
Care Management Provider Agency
Funcdons.
§ 58069.
The Role of the Care Management
Supervisor.
§ 58070.
Staff Qualificafions.
§ 58071.
Staff Ratios.
§ 58072.
Client Bill of Rights and
Responsibilities.
§ 58073.
Quality Assurance.
§ 58074.
Annual Report of the Agency's
Quality Assurance Program.
§ 58075.
Objectivity and Impartiality.
§ 58076.
Policy Manual.
Article 6.
§ 58077.
Issuer Reporting
Requirements and Audit
Information
Issuer Reporting Requirements.
592
Page xvii
(7-18-2008)
Table of Contents
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
Page
Page
§ 58078.
Records Maintenance.
§ 58079.
Reporting to tiie Policy or
Certificate Holder on the Medi-Cal
Property Exemption.
§ 58080.
Preparing a Service Summary.
§58081.
Plan of Action for Information and
Document Maintenance.
§ 58082.
Auditing and Correcting
Deficiencies in Issuer Record
Keeping.
Chapter 11.
Article 1.
§ 59998.
§ 59999.
Drug Formulary and Medical
Supplies Listing 596
Medical Supplies and Medi-
Cal Drug Formulary 596
Medical Supplies.
Medi-Cal Drug Formulary.
Page xviii
(7-18-2008)
Title 22
Health Care Services
§ 50009
Division 3. Health Care Services
Subdivision 1. California Medical
Assistance Program*
(Originally Filed 2-28-66)
Note: Authority cited for Subdivision 1: Sections 14100, 141 05 and 14106, Wel-
fare and Institutions Code. Additional authority cited for regulations filed on
9-30-71: Sections 14005.6, 14106.5, 14122, 14124.5, 14134, W. & 1. Code, and
Sec. 53.6 of Chapter 577, Stats, of 1971. Additional authority cited: Section
14124.5, Welfare and Institutions Code. Additional authority cited for regulation
filed 1-18-74: Sections 10541, 10553.1. 10554, 10554.1, 11004, 1 1050, 1 1100,
14000, 14005.1, 14005.2, 14005.4, 14005.7, 14008, 14016, 14017, 14023, 14051,
14053, 14053.6, 14060, 14061, 14100.1, 14132, 14184 and 14329. Welfare and
Insfitutions Code. Reference: Sections 11004, 11050, 11100. 14000, 14005.1,
14005.2, 14005.4, 14005.6, 14005.7, 14008, 14016, 14017, 14023, 14051, 14053,
14053.6, 14059, 14100.1, 14132, 14133, 14184, 14256, 14261, 14301 and 14329,
Welfare and Institutions Code.
Chapter 1. introduction
§ 50000. Meaning of Words.
Words shall have their usual meaning unless the context or a definition
clearly indicates a different meaning. Shall means mandatory. May
means permissive. Should means suggested or recommended.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14124.5, Welfare and Institutions Code.
History
1 . Repealer of Chapter 1 (Sections 50001-5001 1 , not consecutive) and new Chap-
ter 1 (Sections 50000-50009, 50009.1-50009.3) filed 12-20-76 as an emer-
gency; designated effective 1-1-77. Certificate of Compliance included (Reg-
ister 76, No. 52). For history of former Chapter 1, see Registers 66, Nos. 6 and
36; 67, Nos. 8, 15 and 23; 68, No. 43; 71, No. 40; 72, No. 5; 73, No. 26; 74, No.
3. For history of Subdivision 1, see Register 66, No. 6.
2. Amendment filed 6-22-87; operative 7-22-87 (Register 87, No. 27).
§ 50001 . Department.
NOTE: Authority cited: Sections 10554.1 and 14124.5, Welfare and Institutions
Code. Reference: Sections 17.1, 10000, 10002, 10020, 10021, 10022, 10023,
10024, 10025, 10052, 10058, 10554.1, 10555, 10600, 10608, 10800, 10800.1,
10803, 10806, 10809, 10850, 10851, 10852, 10853, 10900, 10950, 10951, 10952,
10953, 10954, 10956, 10957, 10958, 10959, 10960, 10961, 10962, 10963, 10964,
10965, 11000, 11002, 1 1003, 1 1004, 11005.5, 1 1008, 11008.2, 11008.6, 11008.7,
11008.9, 11008.10, 11018, 11050, 11051, 110.52, 11053, 11054, 11055, 11057,
11100. 11102, 11150, 11151, 11152, 11153.7, 11155, 11157, 11158, 11205,
11257, 11452, 12150, 12152, 12305, 13000, 14000, 14000.2, 14001, 14002,
14003. 14005, 14005.1, 14005.4, 14005.7, 14005.8, 14005.9, 14005.12,
14005.13, 14006, 14007, 14008, 14008.5, 14009, 14011, 14012. 14013, 14014,
14015, 14016, 14017, 14018, 14019, 14023, 14026. 14050.1, 14050.2, 14050.3,
14051, 14052, 14053, 14054, 14057, 14061, 14062, 14063, 14100.1, 14103.6,
14104.3, 14109, 14112, 14115, 14119, 14122, 14124.5, 14133, 14140, 14141,
14142, 14143, 14144, 14201 and 14252, Welfare and Insfitutions Code and Chap-
ter 2, Part 1, Division 1, Article 3.1, Section 306 et seq.. Health and Safety Code,
and to implement, interpret or make specific Chapter 1252, Statutes of 1977 (SB
363), SB 1410 (1978) and SB 1596 (1978).
History
1. Amendment filed 6-30-78 as an emergency; designated effecfive at 1 1 :59 p.m.
on 6-30-78 (Register 78, No. 26).
2. Certificate of Compliance transmitted to OAH 1 0-27-78; filed 1 0-31-78 (Reg-
ister 78, No. 44).
3. Repealer filed 6-22-87; operative 7-22-87 (Register 87, No. 27).
§ 50002. Director.
NOTE: Authority cited: Sections 10554.1 and 14124.5, Welfare and Institutions
Code. Reference: Secfions 17.1, 10000, 10002, 10020. 10021, 10022, 10023,
10024, 10025, 10052, 10058, 10554.1, 10555, 10600, 10608, 10800, 10800.1,
10803, 10806, 10809, 10850, 10851, 10852, 10853, 10900, 10950, 10951, 10952,
10953, 10954, 10956, 10957, 10958, 10959, 10960, 10961, 10962, 10963, 10964,
10965, 1 1000, 1 1002, 1 1003, 1 1004, 1 1005.5, 1 1008, 1 1008.2, 1 1008.6. 1 1008.7.
11008.9, 11008.10, 11018, 11050, 11051, 11052, 11053, 11054, 11055, 11057,
11100, 11102, 11150, 11151, 11152, 11153.7, 11155, 11157, 11158, 11205,
11257, 11452, 12150, 12152, 12305, 13000, 14000, 14000.2, 14001, 14002,
14003, 14005, 14005.1, 14005.4, 14005.7, 14005.8, 14005.9. 14005.12,
14005.13, 14006, 14007, 14008, 14008.5, 14009, 14011, 14012, 14013, 14014,
14015, 14016, 14017, 14018, 14019, 14023, 14026, 14050.1, 14050.2, 14050.3,
14051, 14052, 14053, 14054, 14057, 14061, 14062, 14063, 14100.1, 14103.6,
14104.3, 14109, 14112, 14115. 14119, 14122, 14124.5, 14133, 14140, 14141,
14142, 14143, 14144, 14201 and 14252, Wei fare and Institutions Code and Chap-
ter 2, Pan 1. Division 1, Article 3.1, Section 306 et seq.. Health and Safety Code,
and to implement, interpret or make specific Chapter 1252, Statutes of 1977 (SB
363), SB 1410 (1978) and SB 1596(1978).
History
1 . Amendment filed 6-30-78 as an emergency; designated effective at 1 1 :59 p.m.
on 6-30-78 (Register 78, No. 26).
2. Certificate of Compliance transmitted to OAH 10-27-78; filed 10-31-78 (Reg-
ister 78, No. 44).
3. Repealer filed 6-22-87; operative 7-22-87 (Register 87, No. 27).
§ 50003. Medi-Cal Program.
History
1. Repealer filed 6-22-87; operative 7-22-87 (Register 87, No. 27).
§ 50004. Medi-Cal Program Administration.
(a) The Department is the single state agency approved by the Secre-
tary of the Department of Health and Human Services to administer the
Medi-Cal program.
(b) The Department shall administer the Medi-Cal program in accor-
dance with the following:
(1) The State Plan under Title XTX of the Social Security Act.
(2) Applicable State law, as specified in the Welfare and Institutions
Code.
(3) Medi-Cal regulations.
(c) The county welfare department in each county shall be the agency
responsible for local administration of the Medi-Cal program under the
direction of the Department.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Insfitufions
Code. Reference: Sections 10722, 10743, 1 1050, 14001 .1 and 14100, Welfare and
Institutions Code.
History
1. Amendment filed 6-22-87; operative 7-22-87 (Register 87, No. 27).
§ 50005. Medi-Cal Regulations.
Regulations promulgated by the Department for purposes of adminis-
tering the Medi-Cal program shall be known as Medi-Cal regulations.
These regulations comprise Division 3, Title 22, California Administra-
tive Code.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Insfitutions
Code. Reference: Sections 10060, 10743, 14002 and 14124.5, Welfare and Institu-
tions Code.
History
1. Change without regulatory effect adding NOTE (Register 86, No. 49).
§ 50006. Conformity with Federal Requirements.
History
1 . Repealer filed 6-22-87; operative 7-22-87 (Register 87, No. 27).
§ 50007. Fiscal Intermediary.
Fiscal intermediary, as used in these regulations or in any other docu-
ment pertaining to the Medi-Cal program and its administration, means
any individual, partnership or association, corporation or institution con-
tracting with the Department for the performance of fiscal services re-
lated to the program.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14000.3 and 14104.3, Welfare and Institufions Code.
History
1. Change without regulatory effect adding NOTE (Register 86, No. 49).
§ 50008. Liens.
History
1. Repealer filed 12-31-82 as an emergency; effective upon filing (Register 83,
No. 2). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 4-30-83.
2. Certificate of Compliance transmitted to OAL 4-29-83 and filed 6-3-83 (Reg-
ister 83, No. 23).
§ 50009. Medi-Cal Consultant.
Medi-Cal consultant, as used in these regulations, means the appropri-
ate professional individual employed by the Department to render advice
and determinations in matters related to services provided under Medi-
Page 307
Register 95, No. 45; 11-10-95
§ 50009.1
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
Cal. Appropriate Medi-Cal consultants shall personally review and sign
any document as required by these regulations. Signatory authority of a
Medi-Cal consultant shall not be delegated.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 1411 9, Welfare and Institutions Code.
History
1. Change without regulatory effect adding NOTE (Register 86, No. 49).
§50009.1. Medical Review.
(a) Medical review means a periodic, not less than annual, evaluation
of the health needs of each beneficiary in each mental hospital, skilled
nursing facility and intermediate care facility. Medical Review is con-
ducted by a Medical Review Team on behalf of the Department.
(b) Such review is to determine the quality and adequacy of the ser-
vices being provided each beneficiary, the level of care required to meet
each beneficiary's health needs and the necessity and desirability of the
initial or continued placement of such patient in such facility.
(c) The review shall include a personal contact with and observation
of each beneficiary and a review of each beneficiary's medical record by
a Team member or members. The review may include a medical exami-
nation of the beneficiary by the Medi-Cal consultant when the consultant
deems it necessary.
NOTE: Authority cited: Sections 10725, 10743 and 14124.5, Welfare and Institu-
tions Code. Reference: Sections 14019.5, 14100.1, 14104 and 141 19, Welfare and
Institutions Code.
History
I . Change without regulatory effect adding NOTE (Register 86, No. 49).
§ 50009.2. Medical Review Team.
A Medical Review Team shall be comprised of a physician and other
appropriate health and social service personnel necessary to conduct
medical review.
NOTE; Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14100.1, 14104, 141 19 and 14133.1, Welfare and Insti-
tutions Code.
History
1. Change without regulatory effect adding NOTE (Register 86, No. 49).
§ 50009.3. Health Care Services.
Health care services means the medical services, social services, sup-
plies, devices, drugs and any other medical care to which an eligible per-
son is entitled pursuant to these regulations.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14021, 14053, 14132 and 14136, Welfare and Institu-
tions Code.
History
1. Change without regulatory effect adding NOTE (Register 86, No. 49).
Chapter 2. Determination of Medi-Cal
Eligibility and Share of Cost
Article 1.
Definitions, Abbreviations and
Program Terms
§ 5001 1 . Definitions — General.
The definitions in this article shall apply to Chapter 2 of this division
unless the context requires otherwise.
NOTE: Authority cited for Chapter 2: Sections 10554.1 and 14124.5, Welfare and
Institutions Code. Reference Sections 17.1, 10000, 10002, 10020, 10021, 10022,
10023, 10024, 10025, 10052, 10058, 10554.1, 10555, 10600, 10608, 10800,
10800.1, 10803, 10806, 10809, 10850, 10851, 10852, 10853, 10900, 10950,
10951, 10952, 10953, 10954, 10956, 10957, 10958, 10959, 10960, 10961, 10962,
10963, 10964, 10965, 11000, 11002, 11003, 11004, 11005.5, 11008, 11008.2,
11008.6, 11008.7, 11008.9, 11008.10, 11018, 11050, 11051, 11052, 11053,
11054, 11055, 11057, 11100, 11102, 11150, 11151, 11152, 11153.7, 11155,
11157, 11158, 11205, 11257, 11452, 12150, 12152, 12305, 13000, 14000,
14000.2, 14001, 14002, 14003, 14005, 14005.1, 14005.4, 14005.7, 14005.8,
14005.9, 14005.12, 14005.13, 14006, 14007, 14008, 14008.5, 14009, 14011,
14012, 14013, 14014, 14015, 14016, 14017, 14018, 14019, 14023, 14026,
14050.1, 14050.2, 14050.3. 14051, 14052. 14053. 14054. 14057. 14061. 14062,
14063, 14100.1, 14103.6, 14104.3, I4I09, 141 12, 14115, 14119. 14122. 14124.5,
14133, 14140, 14141, 14142, 14143, 14144, 14201 and 14252, Welfare and Insti-
tutions Code and Chapter 2, Part 1, Division 1, Article 3.1, Section 306 et seq..
Health and Safety Code.
History
1 . Repealer of Chapter 2 (Sections 50024-50750, not consecutive) and new Chap-
ter 2 (Sections 5001 1-50955, not consecutive) filed 12-20-76 as an emergen-
cy; designated effective 1-1-77. Certificate of Compliance included (Register
76. No. 52). For history of former Chapter 2, see Resisters 66, Nos. 6, 19, 30;
67, Nos. 23, 34, 52; 68, Nos. 21.43; 69, Nos. 3, 31; 70, No. 27; 71, Nos. 40, 52;
72, Nos. 5. 1 8. 27, 3 1 , 40, 52; 73. Nos. 4, 1 8. 1 9. 22. 26, 36, 41 , 52; 74, Nos. 3,
) 8, 41, 45. 46; 75, Nos. 6, 17, 23, 32, 48; 76, Nos. 14, 27, 29, 43.
§50012. Abbreviations.
The following abbreviations shall apply to chapter 2 of this division:
ABD. Aged, Blind or Disabled.
ABD-MN. Aged, Blind or Disabled — Medically Needy.
AFDC. Aid to Families with Dependent Children.
AFDC-MN. Aid to Families with Dependent Children —
Medically Needy.
BRU. Benefits Review Unit.
CETA. Comprehensive Employment and Training Act.
CHDP. Child Health and Disability Prevention Program.
EAS. Eligibility and Assistance Standards Manual.
ETS. Employment Training Services.
HlC. Social Security Health Insurance Claim Number.
INS. Immigration and Naturalization Service.
LTC. Long-Term Care.
MBSAC. Minimum Basic Standard of Adequate Care.
MFBU. Medi-Cal Family Budget Unit.
MI. Medically Indigent.
MN. Medically Needy.
OASDI. Old Age Survivors and Disability Insurance.
Other PA. Other Public Assistance.
PA. Public Assistance.
PCCM. Primary Care Case Management.
PHP. Prepaid Health Plan.
POE. Proof of Eligibility.
SDX. State Data Exchange.
SSN. Social Security Number.
SSI/SSP. Supplemental Security Income/State Supplemental
Program.
UIB. Unemployment Insurance Benefits.
WIN. Work Incentive Program.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.1, 14050.1 and 14088, Welfare and Institutions
Code.
History
1. Amendment filed 3-5-81; effective thirtieth day thereafter (Register 81, No.
10).
2. Amendment filed 7-31-81 as an emergency; effective upon filing (Register 81,
No. 33). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 1 1-28-81.
3. Certificate of Compliance transmitted to OAL 11-6-81 and filed 1-27-82
(Register 82, No. 5)
4. Amendment filed 3-9-90 as an emergency; operative 3-9-90 (Register 90, No.
12). A Certificate of Compliance must be transmitted to OM^ within 120 days
or emergency language will be repealed on 7-9-90.
5. Amendment refiled 7-9-90 as an emergency; operative 7-9-90 (Register 90,
No. 35). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed by operation of law on 1 1-6-90.
6. Request to readopt amendment on an emergency basis pursuant to Government
Code section 11346.1 granted and filed 11-6-90 as an emergency; operative
1 1-6-90 (Register 91 , No. 6). A Certificate of Compliance must be transmitted
to OAL by 3-6-91 or emergency language will be repealed by operation of law
on the following day.
7. Certificate of Compliance as to 1 1-6-90 order transmitted to OAL 2-22-91 ;
disapproved by OAL on 3-25-91 (Register 91, No. 18).
8. Amendment filed 3-25-91 as an emergency; operative 3-25-91 (Register 91,
No. 18). A Certificate of Compliance must be transmitted to OAL by 7-23-91
or emergency language will be repealed by operation of law on the following
day.
Page 308
Register 95, No. 45; 11-10-95
Title 22
Health Care Services
§ 50025.3
•
9. Certificate of Compliance as to 3-25-9 1 order transmitted to OAL 7-19-91 and
filed 8-19-91 (Register 92, No. 1).
§50013. Adequate Consideration.
Adequate consideration means the receipt of cash or property which
is fair and reasonable under the circumstances considering the net market
value of properly that is sold, converted or transferred.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14015, Welfare and Institutions Code.
History
1 . Editorial correction adding NOTE filed 7-7-83 (Register 83, No. 29).
§50014. Adult.
(a) Adult means:
(1) A person who is 21 years of age or older.
(2) A blind or disabled MN person who is 18 to 21 years of age, living
in the home of a parent and not currently enrolled in school, college, uni-
versity, or a course of vocational or technical training to prepare him/her
for gainful employment.
(3) A person who is 1 8 to 21 years of age, who is not living in the home
of a parent or caretaker relative, is not claimed as a tax dependent of his/
her parent(s) and is not receiving out-of-home care from a public
agency.
(4) A person 14 to 18 years of age who is not living in the home of a
parent or caretaker relati ve and who does not have a parent, caretaker rel-
ative or legal guardian handling any of his/her financial affairs.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Secfions 14005.4, 14005.7, 14008 and 14010, Welfare and Insti-
tutions Code.
History
1 . Amendment filed 1-8-81 ; effecfi ve thirtieth day thereafter (Register 81 , No. 2).
2. Amendment of subsection (a)(2), repealer of subsection (a)(3), subsection re-
numbering, amendment of newly designated subsection (a)(4), and amendment
of Note filed 12-9-97; operative 1-8-98 (Register 97, No. 50).
§50015. Adverse Action.
(a) Adverse action means an action taken by a county department
which discontinues Medi-Cal eligibility or increases an MFBU's share
of cost. The following shall not be considered to be adverse actions:
(1) Discontinuance due to any of the following reasons:
(A) Death, for a one-person MFBU.
(B) The whereabouts of the beneficiary is unknown and the post office
has returned county department mail directed to the beneficiary indicat-
ing no forwarding address.
(C) Admission to an institution which renders the beneficiary ineligi-
ble.
(D) The beneficiary also has Medi-Cal eligibility under another iden-
tity or category, or in another county or state; or will have such dual eligi-
bility as of the first of the coming month if discontinuance action is not
taken.
(E) Receipt of the beneficiary's clear and signed written statement that
does either of the following:
1. States the beneficiary no longer wishes Medi-Cal benefits.
2. Gives information that requires discontinuance and includes the
beneficiary's acknowledgment that this must be the consequence of sup-
plying such information.
(2) An increase in an MFBU's share of cost due to either of the follow-
ing:
(A) The voluntary inclusion of eligible family members who currently
are not receiving benefits under any Medi-Cal program.
(B) Receipt of the beneficiary's clear and signed statement which
gives information which requires an increase in the share of cost and in-
cludes the beneficiary's acknowledgment that this must be the conse-
quence of supplying such information.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Insfitutions
Code. Reference: Sections 10721, 10950 and 11050, Welfare and Insfitutions
Code.
History
1 . Amendment filed 12-15-77; effective thirtieth day thereafter (Register 77, No.
51).
2. Amendment filed 5-30-80 as an emergency; effective upon filing (Register 80,
No. 22). A Certificate of Compliance must be transmitted to OAH within 120
days or emergency language will be repealed on 9-27-80.
3. Certificate of Compliance filed 9-26-80 (Register 80, No. 39).
4. Amendment of subsection (a)(2)(A) filed 7-9-87: operative 8-8-87 (Register
87, No. 30).
§50016. Aid.
Aid means cash assistance, food stamps or Medi-Cal.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14050.2, Welfare and Institutions Code.
History
1. Editorial con-ection adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 50017. Aid Category.
Aid category means the specific category under which a person is eli-
gible to receive Medi-Cal.
§50018. Aid Code.
Aid code means the two-digit number which indicates the aid category
under which a person is eligible.
§ 50019. Aid to Families with Dependent Children (AFDC).
Aid to Families with Dependent Children (AFDC) means the public
assistance program that provides a cash grant and Medi-Cal to children
deprived of parental support or care and their eligible relatives.
§ 50020. Aid to the Potentially Self-Supporting Blind
(APSB).
NOTE: Authority cited: Sections 10725, and 14124.5, Welfaie and Insfitutions
Code. Reference: Secfions 14005.1, and 14050.1, Welfare and Insfitufions Code.
History
1 . Repealer filed 7-31-81 as an emergency; effective upon filing (Register 8 1 , No.
33) A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on 1 1-28-81 .
2. Certificate of CompHance transmitted to OAL 11-6-81 and filed 1-27-82
(Register 82, No. 5).
§50021. Applicant.
Applicant means the individual or family making, or on whose behalf
is made, an applicafion, request for restoradon of aid or reapplication.
§ 50022. Application.
Applicafion means a written request for aid.
§ 50023. Approval of Eligibility.
Approval of eligibility means the determination made by the county
department that a person or family is eligible for Medi-Cal.
§ 50024. Beneficiary.
Beneficiary means a person who has been determined eligible for
Medi-Cal.
NOTE: Authority cited; Sections 10725 and 14124.5, Welfare and Institufions
Code. Reference: Secfion 14252, Welfare and Insfitutions Code.
History
1 . Editorial correction adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 50025. Benefits Review Unit (BRU).
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Insfitufions
Code. Reference: Section 14016, Welfare and Institutions Code.
History
1 . Editorial correcfion adding NOTE filed 7-7-83 (Register 83, No. 29).
2. Repealer filed 7-3-86; effective thirtieth day thereafter (Register 86, No. 27).
§ 50025.3. Board and Care.
(a) Board and care means receipt of board, room, personal care and
designated supplemental services related to individual needs in one of the
following nonmedical protective living environinents certified in accor-
dance with HAS 46-325.3 for a full calendar month:
(1) A licensed residential care facility.
(2) The home of a relative or legally appointed guardian or conserva-
tor, other than the home of a spouse or the home of a parent for a blind
or disabled child.
Page 309
Register 97, No. 50; 12-12-97
§ 50025.5
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
(3) A home in which a child is placed by a court under Welfare and
Institutions Code 727(a).
(4) An exclusive use home approved by a licensed home finding
agency.
NOTE: Authority cited: Seclion.s 10725 and 14124.5, Welfare and lnstitution.s
Code. Reference: Section 14005.13, Welfaie and Institutions Code.
History
1 . New section filed 1 -8-81 ; effective thirtieth day thereafter (Register 81 . No. 2).
§ 50025.5. Burial Insurance.
Burial insurance means insurance which by its terms can only be used
to pay the burial expenses of the insured.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14006, Welfare and Institutions Code.
History
1 . New .section filed 3-7-80; as an emergency; effective upon filing (Register 80,
No. 9). A Certificate of Compliance must be transmitted to OAH within 120
days or emergency language will be repealed on 7-6-80.
2. Certificate of Compliance filed 6-6-80 (Register 80, No. 23).
3. Editorial cortcction of NOTE filed 7-7-83 (Register 83, No. 29).
§ 50025.6. California Standard Nomenclature (CSN), 1979.
NOTE: Authority cited: Section 57(c), Chapter 328, Statutes of 1982; Section
14124.5, Welfare and Institutions Code. Reference: Sections 14132, 14133 and
14122.1. Welfare and Institutions Code; and Section 53. Chapter 328. Statutes of
1982.
History
1 . New section filed 6-24-83 as an emergency; effective upon filing (Register 83,
No. 26). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 10-22-83.
2. Certificate of Compliance transmitted to OAL 10-21-83 and filed 11-23-83
(Register 83, No. 48).
3. Editorial correction renumbering Section 50025.6 to Section 51050 filed
12-20-83 (Register 83, No. 52).
§ 50026. Cash Grant.
Cash grant means the money payment made to a person eligible for
AFDC, EVH or SSI/SSP.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.1 and 14050.1, Welfare and Institutions Code.
History
1. Amendment filed 7-31-81 as an emergency; effective upon filing (Register 81,
No. 33) A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 1 1-28-81 .
2. Certificate of Compliance transmitted to OAL 11-6-81 and filed 1-27-82
(Register 82, No. 5).
§ 50027. Certification Date for Claims Clearance.
Certification date for claims clearance means the date of the most re-
cent service listed on the Record of Health Care Costs, MC 177S or MC
177P.
§ 50028. Certification — Effective Date.
Effective date of certification for Medi-Cal means the date the person
is certified to receive Medi-Cal benefits.
§ 50029. Certification for Medi-Cal.
Certification for Medi-Cal means the determination by the county de-
partment or the Department that a person is eligible for Medi-Cal and has
no share of cost, has met the share of cost or is in long-term care and has
a share of cost which is less than the cost of long-term care at the Medi-
Cal rate.
§ 50029.5. Certified Long-Term Care Insurance Policy or
Certificate.
Certified Long-Term Care Insurance Policy or Certificate means any
long-term care insurance policy or certificate certified by the Depart-
ment of Health Services and approved for issue or delivery to California
residents by the Department of Insurance as meeting the requirements set
forth in Section 22005(e) of the Welfare and Institutions Code.
NOTE: Authority cited: Section 22009(a), Welfare and Institutions Code. Refer-
ence: Sections 22004, 22005 and 22006, Welfare and Institutions Code.
History
1. New section filed 1 1-1-93 as an emergency: operative 1 1-1-93 (Register 93,
No. 45). A Certificate of Compliance must be transmitted to OAL by 3-1-94
or emergency language will be repealed by operation of law on the following
day.
2. Certificate of Compliance as to 1 1-1-93 order transmitted to OAL 2-1 7-94 and
filed 3-31-94 (Register 94, No. 1 3).
§50030. Child.
(a) Child means a person under the age of 21 except for those persons
who are specified as adults in Section 50014.
(b) An unborn is considered a child for Medi-Cal purposes.
NOTE: Authority cited: Sections 10725 and 14124.5. Welfare and Institutions
Code. Reference: Sections 12305, 12305.5. 14001, 14005.1,14005.4, 14005.7,
14008, 14010, 14011, 14017, 14018, 14051, 14051.5, and 14052, Welfare and In-
stitunons Code; Sections 25.6, 34.7. 34.9 and 34.10, Civil Code.
History
1. Amendment of subsection (a)(3) filed 10-31-78 as an emergency; designated
effective 1 1-1-78 (Register 78, No. 44).
2. Certificate of Compliance filed 2-6-79 (Register 79, No. 6).
3. Amendment filed 1-8-8 1 ; effective thirtieth day thereafter (Register 8 1, No. 2).
4. Amendment of subsection (a), repealer of subsections (a)( I )-(a)(4) and amend-
ment of Note filed 12-9-97; operative 1-8-98 (Register 97, No. 50).
§ 50031 . Child Health and Disability Prevention Program
(CHDP).
Child Health and Disability Prevention Program (CHDP) means the
community based program for early identification and referral for treat-
ment of persons under 21 years of age with potentially handicapping con-
ditions.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Insfitutions
Code. Reference; Sections 14053 and 14100.1, Welfare and Institutions Code;
Section 320, Health and Safety Code.
History
1. Editorial cortection adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 50032. Competent.
Competent means being able to act on one's own behalf in business
and personal matters.
§ 50033. Contiguous Property.
Contiguous property means adjacent or adjoining property that is not
separated by a road, street, right of way or in any other manner from prop-
erty being considered.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14006, Welfare and Institutions Code.
History
1. Editorial con-ection adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 50034. Conversion of Property.
Conversion of property means changing property from one form to
another without changing ownership.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14006 and 14015, Welfare and Insfitutions Code.
History
1. Editorial con-ection adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 50035. County Agency.
County agency means either an administrative division of a county
government or a noncounty organization that has a contract with the
county to act on the county's behalf.
§ 50035.5. County Cash-Based Medi-Cal Eligibility.
County cash-based Medi-Cal eligibility means eligibility for Medi-
Cal benefits which is based upon a county department determination of
eligibility for a cash grant or IHSS.
NoTE: Authority cited: Sections 10725 and 14124.5, Welfare and Insfitutions
Code. Reference: Sections 14005.1 and 14050.1, Welfare and Institutions Code.
History
1. New section filed 3-5-81; effective thirtieth day thereafter (Register 81, No.
10).
Page 310
Register 97, No. 50; 12-12-97
Title 22
Health Care Services
§ 50043
§ 50036. County Department.
County department means the department authorized by the county
board of supervisors to administer aid programs, including Medi-Cal.
§ 50036.5. County Case Error Rate.
The county case error rate means the number of quality control case
reviews found in error divided by tiie total number of completed case re-
views in that county, exclusive of state caused errors.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and ln.stitutions
Code. Reference: Section 14016(g), Welfare and Institutions Code.
History
1 . New section filed 7-6-83 as an emergency; elfective upon filing (Register 83,
No. 33). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 1 1-3-83.
2. Certificate of Compliance transmitted to OAL 11-3-83 and filed 12-6-83
(Register 83, No. 50).
3. Corrected Certificate of Compliance as to 7-6-83 order filed 1-9-84 (Register
84, No. 2).
4. Amendment filed 5-15-92; operative 6-15-92 (Register 92, No. 21).
§ 50036.6. Dependent Relative.
NOTE; Authority cited: Sections 10725, 14006.1 and 14124.5, Welfare and Insti-
tutions Code. Reference: Section 14006, Welfare and Institutions Code.
History
1 . New section filed 7-24-84 as an emergency; effective upon filing (Register 84,
No. 31). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 1 1-21-84.
2. Order of Repeal of 7-24-84 emergency order filed 12-20-84 by OAL pursuant
to Government Code Section 1 1349.6 (Register 84, No. 51).
§ 50037. Eligibility and Assistance Standards Manual
(HAS).
Eligibility and Assistance Standards Manual (EAS) means the portion
of the Manual of Policies and Procedures published by the State Depart-
ment of Benefit Payments which includes regulations pertaining to the
AFDC, APSB, SSP and EVH programs.
§ 50037.5. Eligibility Quality Control.
(a) Eligibility quality control means both of the following:
(1) Federally mandated review of Medi-Cal cases to ensue proper de-
termination of eligibility.
(2) State mandated review of Medi-Cal cases within individual coun-
ties to ensure proper determination of eligibility.
NOTE: Authority cited: Secdons 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14016 (b), (d) and (e)(1) and 14100.1, Welfare and In-
stitutions Code.
History
1 . New section filed 7-6-83 as an emergency; effective upon filing (Register 83,
No. 33). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 1 1-3-83.
2. Certificate of Compliance transmitted to OAL 11-3-83 and filed 12-6-83
(Register 83, No. 50).
3. Corrected Certificate of Compliance as to 7-6-83 order filed 1-9-84 (Register
84, No. 2).
§ 50038. Eligibility Services.
Eligibility services means those services provided by the county de-
partment relating to the initial and continuing determination of a person's
or family's Medi-Cal eligibility.
§ 50038.5. Emergency Assistance (EA).
(a) Emergency Assistance (EA) means the public assistance programs
that provide assistance for 30 days to:
(1) Families not meeting the qualifications for the federal AFDC-U
program.
(2) Those children who are being, or are in immediate danger of being
abused, neglected or exploited and to families of such children.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; and Section 87(c), Chapter 1594, Statutes of 1982. Reference: Sections
11250.5, 1 1406.5 and 14005.1, Welfare and Institutions Code; and Department of
Social Services Manual of Policies and Procedures, EiigibiUty and Assistance
Standards, Section 45-401.2 (incorporated into Title 22, California Administra-
tive Code).
History
1. New section filed 12-31-82 as an emergency; effective upon filing (Register
83, No. 2). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 4-30-83.
2. Certificate of Compliance transmitted to OAL 4-13-83 and filed 5-16-83
(Register 83, No. 21).
3. Editorial coirection of subsecfions (a)(1) and (2) filed 5-16-83 (Register 83,
No. 21),
§ 50039. Encumbrances of Record.
Encumbrances of record means obligations for which property is secu-
rity, as evidenced by a written document.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14006, Welfare and Institutions Code.
History
1. Editorial cortection adding NOTE filed 7-7-83 (Register 83. No. 29).
2. Amendment filed 6-3-87; operative 7-3-87 (Register 87, No. 24).
§ 50040. Fair Market Value.
NOTE: Authority cited: Sections 10725, 14006.1 and 14124.5, Welfare and Insti-
tutions Code. Reference: Section 14006, Welfare and Institutions Code.
History
1 . New section filed 7-24-84 as an emergency; effective upon filing (Register 84,
No. 31). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 1 1-21-84.
2. Order of Repeal of 7-24-84 emergency order filed 12-20-84 by OAL pursuant
to Government Code Section 11349.6 (Register 84, No. 51).
§ 50041 . Family Member.
(a) Family member means the following persons living in the home:
(1) A child or sibling children.
(2) The parents married or unmarried of the sibling children.
(3) The stepparents of the sibling children.
(4) The separate children of either unmarried parent or of the parent
or stepparent.
(b) If there are no children, family member means a single person or
a married couple.
NOTE; Authority cited: Sections 10725 and 14124.5, Welfare and Insfitutions
Code. Reference-. Sections 14051, 14052 and 14008, Welfare and Institutions
Code.
History
1 . Amendment filed 1-8-81 ; effective thirtieth day thereafter (Register 81, No. 2).
§ 50041 .5. Federal Poverty Level.
The federal poverty level means an income level based on the official
poverty line as defined by the federal Office of Manageinent and Budget
and revised annually or at any shorter interval the Secretary of Health and
Human Services deems feasible and desirable pursuant to Section
9902(2). Title 42, United States Code.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; and Section 12, Chapter 1430, Statutes of 1989. Reference: Section
14005.3, Welfare and Institutions Code; and Section 9902(2), Title 42, United
States Code.
History
1. New section filed 10-3-94 as an emergency; operative 10-3-94 (Register 94,
No. 40). A Certificate of Compliance must be transmitted to OAL by 1-31-95
or emergency language will be repealed by operation of law on the following
day.
2. Editorial coiTection of History Note 1 (Register 95, No. 9).
3. Repealed by operation of Government Code secfion 1 1346.1(g) (Register 95,
No. 9).
4. New section refiled 3-3-95 as an emergency; operative 3-3-95 (Register 95,
No. 9). A Certificate of Compliance must be transmitted to OAL by 7-1-95 or
emergency language will be repealed by operation of law on the following day.
5. Certificate of Compliance as to 3-3-95 order including amendment of section
transmitted to OAL 2-22-95 and filed 4-5-95 (Register 95, No. 14).
§50042. Foster Child.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4 and 14005.7, Welfare and Institutions Code.
History
1 . Repealer filed 8-8-80; effective thirtieth day thereafter (Register 80, No. 32).
§50043. Heirloom.
Heirloom means any item of personal property, other than cash and se-
curities, which has substantially sentimental value, has been owned by
Page 311
Register 97, No. 50; 12-12-97
§ 50044
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
a family lor ai least two generations and is intended to be retained by the
family in succeeding generations.
§ 50044. Home.
Home means real or personal property, fixed or mobile, located on
land or water, in which a person or family lives.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14006, Welfare and Institutions Code.
History
1. Editorial conection adding NOTE filed 7-7-83 (Register 83. No. 29).
§ 50045. immigration and Naturalization Service (INS).
Immigration and Naturalization Service (INS) means the branch of the
United States Government that administers regulations regarding aliens
in the United States.
§ 50045.1 . Impairment Related Work Expenses (IRWE).
"Impairment Related Work Expenses" (IRWE) means those expenses
of a working disabled QMB or SLMB program applicant/beneficiary
which are necessary to become or remain employed. Such expenses in-
clude but are not limited to expenses which are:
(a) Required to control a disabling condition, thereby enabling the in-
dividual to work;
(b) Essential to meet the functional demands of a job, e.g., wheel-
chairs, respirators, prosthesis, attendant care;
(c) Necessary in preparing for work, in traveling to and from work, or
assistance needed immediately upon returning from work (e.g., attendant
care services, transportation costs, exterior ramps, and railing or path-
ways modified to the exterior of the applicant' s/beneficiary ' s residence).
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections ]382a(b) and 1396a(a), Title 42, United States Code;
and Section 14005.1 1, Welfare and Institutions Code.
History
1. New section filed 8-13-90 as an emergency; operative 8-13-90 (Register 90,
No. 40). A Cenificate of Compliance must be transmitted to OAL by 12-1 1-90
or emergency language will be repealed by operation of law on the following
day.
2. Certificate of Compliance transmitted to OAL 12-11-90 and filed 1-9-91
(Register9I,No. 8).
3. Amendment of opening statement filed 12-21-93; operative 1-20-94 (Register
93, No. 52).
§ 50045.3. Income and Eligibility Verification System.
The Income and Eligibility Verification System (lEVS) is the federal-
ly mandated system established to obtain, use and verify information
relevant to determination of eligibility and share of cost.
NOTE: Authority cited: Sections 10725, 10740 and 14124.5, Welfare and Institu-
tions Code. Reference: Sections 1 1025, 14001 and 14016.9, Welfare and Institu-
tions Code; and 42 Code of Federal Regulations 435.940.
History
I. New section filed 7-16-87; operative 7-16-87 pursuant to Government Code
Section 11346.2(d) (Register 87, No. 30).
§ 50045.5. In-Home Supportive Services.
In-Home Supportive Services (IHSS) means the social services pro-
gram which provides necessary personal and domestic care so that aged,
blind and disabled persons may remain in their own homes.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institufions
Code. Reference: Sections 12305, 12305.5, 14001, 14005.1, 14005.4, 14005.7,
14008, 14008.5, 14010, 14011, 14017, 14018 and 14051.5, Welfare and Institu-
tions Code; Sections 25.6, 34.5, 34.7, 34.9 and 34.10, Civil Code.
History
1. New section filed 10-31-78 as an emergency; designated effective 11-1-78
(Register 78, No. 44).
2. Certificate of Compliance filed 2-6-79 (Register 79, No. 6).
§ 50046. Inmate.
Inmate means a person living or being cared for in an institution. Ex-
cluded from this definition are persons residing at a facility for vocational
training or educational purposes, and persons temporarily in an institu-
tion pending more suitable arrangements, such as children in a local
agency facility pending foster care placement.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 11014, 11016 and 14053, Welfare and Institutions
Code.
History
1. Amendment filed 4-1-83; effective thirtieth day thereafter (Register 83, No.
14).
§ 50047. Institution.
Institution means an establishment which provides food and shelter to
four or more persons unrelated to the proprietor and in addition provides
some treatment or services which meet needs beyond the basic provision
of food and shelter.
§ 50048. Institution— Medical.
Medical institution means any public or private acute care hospital,
acute psychiatric hospital, intermediate care facility, skilled nursing fa-
cility, or other medical facility licensed by an officially designated state
standard setting authority.
§ 50049. Institution — Mental Diseases.
An institution for mental diseases means an institution primarily en-
gaged in providing diagnosis, treatment or care for persons with mental
illness.
§ 50050. Institution — Nonmedical.
Nonmedical institution means any institution providing nonmedical
residential care, custodial care, custody or restraint. This includes penal
institutions.
§50051. Institution— Private.
A private institution means a proprietary or nonprofit facility managed
and controlled by an individual, private association or corporation.
§ 50052. Institution— Public.
Public institution means an institution that is the responsibility of a
governmental unit or over which a governmental unit exercises adminis-
trative control. Excluded from this definition are medical facilities and
publicly operated community residences designed to serve and serving
no more than sixteen persons.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and InstiUitions
Code. Reference: Sections 11014, 11016 and 14053, Welfare and Institutions
Code.
History
1. Amendment filed 4-1-83; effective thirtieth day thereafter (Register 83, No.
14).
§ 50052.5. Institution — Tuberculosis.
Tuberculosis institution means an institution which is primarily en-
gaged in providing diagnosis, treatment or care of persons with tubercu-
losis, including medical attention, nursing care and related services.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14053(1 4)(b), Welfare and Institutions Code.
History
1 . New section filed 3-7-80; effective thirtieth day thereafter (Register 80, No. 9).
§ 50053. Intraprogram Status Change.
Intraprogram status change means a change in a person's or family's
eligibility from one aid category to another aid category, in which the first
digit of the aid code remains the same.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 10743 and 14100.1, Welfare and Institutions Code.
History
1. Editorial correction adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 50054. Interprogram Transfer.
Interprogram transfer means a transfer of eligibility from one aid cate-
gory to another aid category, in which the first digit of the aid code
changes.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 10743 and 14100.1, Welfare and Institutions Code.
History
1 . Editorial correction adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 50054.5. Life Insurance.
Life insurance means a contract for which premiums are paid during
the lifetime of the insured, and on which the insuring company pays the
Page 312
Register 97, No. 50; 12-12-97
Title 22
Health Care Services
§ 50060.6
face amount of the policy to the beneficiary upon the death of the insured.
Life insurance may also be purchased by a single premium or by letting
dividends accumulate.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 1 1 158 and 14006, Welfare and Institutions Code.
History
1 . New section filed 3-7-80 as an emergency; effective upon filing (Register 80,
No. 9). A Certificate of Compliance must be transmitted to OAH within 120
days or emergency language will be repealed on 7-6-80.
2. Certificate of Compliance filed 6-6-80 (Register 80, No. 23).
§ 50054.7. Limited Service Status.
Limited service status means that the beneficiary's use of the Medi-
Cal card is limited because of enrollment in a noncomprehensive PHP or
PCCM plan, improper utilization of service, application as a child under
Section 50147.1 or participation in a pilot project conducted by the De-
partment.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 1 40 1 0. 1 40 1 7, 1 4088. 1 6 and 1 4088.4, Wei fare and In-
stitutions Code.
History
1. New section filed 8-8-80; effective thirtieth day thereafter (Register 80, No.
32).
2. Amendment filed 3-9-90 as an emergency; operative 3-9-90 (Register 90, No.
12). A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on 7-9-90.
3. Amendment refiled 7-9-90 as an emergency; operauve 7-9-90 (Register 90,
No. 35). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed by operation of law on 1 1-6-90.
4. Request to readopt amendment on an emergency basis pursuant to Government
Code section 1 1346.1 granted and filed 1 1-6-90 as an emergency; operative
1 1-6-90 (Regisler91 , No. 6). A Certificate of Compliance must be transmitted
to OAL by 3-6-91 or emergency language will be repealed by operation of law
on the following day.
5. Certificate of Compliance as to 1 1-6-90 order transmitted to OAL 2-22-91 ;
disapproved by OAL on 3-25-91 (Register 91, No. 18).
6. Amendment filed 3-25-91 as an emergency; operative 3-25-91 (Register 91,
No. 18). A Certificate of Compliance must be transmitted to OAL by 7-23-91
or emergency language will be repealed by operation of law on the following
day.
7. Certificate of Compliance as to 3-25-9 1 order transmitted to OAL 7-19-91 and
filed 8-19-91 (Register 92, No. 1).
§ 50055. Linked.
Linked means meeting the SSI/SSP requirements of age, blindness or
disability or the AFDC requirements of deprivation of parental support
or care.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.7 and 14051, Welfare and Institutions Code.
History
1. Editorial correction adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 50056. Long-Term Care (LTC).
Long-term care (LTC) means inpatient medical care which lasts for
more than the month of admission and is expected to last for at least one
full calendar month after the month of admission.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institufions
Code. Reference: Section 14050.3, Welfare and Institutions Code.
History
1. Editorial con:ection adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 50057. Marriage.
Marriage means the state of being married, including a legal common
law marriage, as defined in Section 4100 et seq., Chapter 2, Division 4,
Part 5, Title I, California Civil Code.
§ 50058. IVIedi-CaL
Medi-Cal means California's medical assistance program and the
benefits available under that program.
§ 50059. Medi-Cal Card.
Medi-Cal card means a computer printed or hand typed card issued
each month to a person certified to receive Medi-Cal in order to identify
the person as a Medi-Cal beneficiary and authorize the receipt of Medi-
Cal covered services by that person.
§ 50059.5. State Dollar Error Rate.
The state dollar error rate means the Medicaid dollar error rate re-
ported to the Department by the United States Department of Health and
Huinan Services, less any portion of this error rate attributable to state
caused errors.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14016(g), Welfare and Institutions Code.
History
1 . New section filed 7-6-83 as an emergency; effective upon filing (Register 83,
No. 33). A Certificate of Compliance must be transinitted to OAL within 120
days or emergency language will be repealed on 1 1-3-83.
2. Certificate of Compliance transmitted to OAL 11-3-83 and filed 12-6-83
(Register 83, No. 50).
3. Coirected Ceitificate of Compliance as to 7-6-83 order filed 1-9-84 (Register
84, No. 2).
4. Amendment filed 5-15-92; operafive 6-15-92 (Register 92, No. 21).
§ 50059.6. Federal Standard.
"Federal standard" means the Medicaid dollar error rate standard to
which the State is held accountable by the Federal Government.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14016(g), Welfare and Institutions Code.
History
1 . New section filed 8-23-83 as an emergency; effective upon filing (Register 83,
No. 38). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 12-21-83.
2. Certificate of Compliance filed 12-12-83 (Register 83, No. 50).
3. Amendment filed 5-15-92; operative 6-15-92 (Register 92, No. 21).
§ 50059.7. State Caused Errors.
State caused errors means case errors in a county for which the state
assumes responsibility.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14016(g), Welfare and Institutions Code.
History
1. New section filed 5-15-92; operative 6-19-92 (Register 92, No. 21).
§ 50060. Medi-Cal Family Budget Unit (MFBU).
Medi-Cal Family Budget Unit (MFBU) means the persons who will
be included in the Medi-Cal eligibility and share of cost determination.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4, 14005.7 and 14008, Welfare and Institutions
Code.
History
1. Editorial con-ection of NOTE filed 7-7-83 (Register 83, No. 29).
§ 50060.5. Medi-Cal-Only Eligibility.
Medi-Cal-only eligibihty means a person's or family's eligibility for
Medi-Cal benefits that has been determined independently of an eligibil-
ity determination for any other aid or benefit program.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14005, Welfare and Institutions Code.
History
1. New section filed 8-7-78; effective thirtieth day thereafter (Register 78, No.
32).
2. Editorial correction adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 50060.6. Medical Support.
Medical support is any liability or payment for the purpose of medical
care available under a court or administrative order, including but not
limited to health insurance, specific dollar amounts for medical purposes,
and payments for medical care from any third party.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14008.6, 14023 and 14024, Welfare and Institutions
Code; 42 CFR, Section 301.1.
History
1. New section filed 4-16-93 as an emergency; operative 4-16-93 (Register 93,
No. 16). A Certificate of Compliance must be transmitted to OAL 8-16-93 or
emergency language will be repealed by operaUon of law on the following day.
2. Certificate of Compliance as to 4-16-93 order transmitted to OAL 8-13-93 and
filed 9-23-93 (Register 93, No. 39).
Page 313
Register 97, No. 50; 12-12-97
§ 50061
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
§ 50061 . Medically Indigent (Ml) Person or Family.
Medically indigent (MI) person or family means a person or family eli-
gible under the Medically Indigent program.
§ 50062. Medically Needy (MN) Person or Family.
Medically needy (MN) person or family means a person or family eli-
gible under the Medically Needy program.
§ 50063. Minimum Basic Standard of Adequate Care
(MBSAC).
Minimum Basic Standard of Adequate Care (MBSAC) means the
amount necessary to provide an AFDC family with basic needs as speci-
fied in the HAS manual.
§ 50063.5. Minor Consent Services.
(a) Minor consent services means services related to:
(1) Sexual assault.
(2) Drug or alcohol abuse for children 12 years of age or older.
(3) Pregnancy.
(4) Family planning.
(5) Venereal disease for children 12 years of age or older.
(6) Sexually transmitted diseases designated by the Director for chil-
dren 12 years of age or older.
(7) Mental health care for children 1 2 years of age or older who are ma-
ture enough to participate intelligently and which is needed to prevent the
children from seriously harming themselves or others or because the chil-
dren are the alleged victims of incest or child abuse.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14010, Welfare and Institutions Code; and Sections 25.9
and 34.7, Civil Code.
History
1. New section filed 4-28-82; effective thirtieth day thereafter (Register 82, No.
18).
§ 50064. Multiple Dwelling Unit.
Multiple dwelling unit means any dwelling with more than one sepa-
rate living unit, that is, a unit which normally would include as a mini-
mum a bathroom and a kitchen.
§ 50064.5. Nonrecurring Lump Sum Payment.
Nonrecurring lump sum payment means a payment accrued over more
than one calendar month and not expected to be received again in the fu-
ture. It does not include the amount of the monthly benefit normally at-
tributable to the month for which eligibility is being determined.
History
1 . New section filed 1 2-15-77; effective thirtieth day thereafter (Register 77, No.
51).
§ 50065. Obligate.
Obligate means to incur a cost for health care services.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.9 and 14019.3, Welfare and Institutions Code.
History
1. Editorial correction adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 50066. Other Public Assistance (Other PA) Recipient.
Other Public Assistance (Other PA) recipient means a person ehgible
for Medi-Cal under one of the categories in the Other Public Assistance
program.
§ 50067. Overpayment.
Overpayment means the receipt of Medi-Cal benefits when there is no
entitlement to all or a portion of the benefits received.
NotE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14009, 14014, 14023 and 14024, Welfare and Institu-
tions Code.
History
1. Editorial correction adding NOTE fUed 7-7-83 (Register 83, No. 29).
§ 50068. Parent.
Parent means the natural or adoptive parent of a child.
NOTE: Authority cited: Sections 10725 and 14124.5. Welfare and Institutions
Code. Reference: Sections 14008. 14051 and 14052, Welfaie and Institutions
Code.
History
1. Editorial correction adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 50068.5. Parent— Minor.
Minor parent means a person who meets the definition of a child and
has his or her own child or children living in the home.
NOTE: Authority cited: Sections 10725 and 14124.5. Welfare and Institutions
Code. Reference: Sections 14008, 14010. 14051 and 14052, Welfare and Institu-
tions Code.
History
1 . New section filed 12-9-97; operative 1-8-98 (Register 97, No, 50).
§ 50069. Parents — Unmarried.
Unmarried parents means parents who are living together with their
common child and the parents are not married to each other.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14008, 14051 and 14052, Welfaie and Institutions
Code.
History
1. Editorial con-ection adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 50069.5. Parent— Unmarried Minor.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14008, 14051 and 14052, Welfare and Institutions
Code.
History
1 . New section filed 1-8-81 ; effective thirtieth day thereafter (Register 81, No. 2).
2. Repealer filed 12-9-97; operative 1-8-98 (Register 97, No. 50).
§ 50070. Patient.
Patient means a person receiving individual professional services di-
rected by a licensed practitioner of the healing arts towards maintenance,
improvement, or protection of health, or the alleviation of disability or
pain.
§ 50071 . Persons Living in the Home.
(a) Persons living in the home means all of the following:
(1) Persons physically present in the home;
(2) Persons temporarily absent from the home because of hospitaliza-
tion, visiting, vacation, trips in connection with work, or because of simi-
lar reasons as Umited by (d).
(3) Persons away at school or vocational training who will resume liv-
ing in the home as evidenced by the person returning home for vacations,
weekends and at other times.
(b) A temporary absence is normally one in which the person leaves
and returns to the home in the same month or the following month.
(c) Whether a person is living in the home while in LTC or board and
care shall be determined in accordance with Section 50-577.
(d) A child, other than specified in (e), temporarily absent from the
home in accordance with (a)(2) shall be considered to be living in the
home as long as the parent continues to have responsibility for the care
and control of the child. A parent continues to have responsibility for the
care and control of a child until the court removes this responsibility or
the parent voluntarily relinquishes it in accordance with Department of
Social Services, Manual of Policies and Procedures, Division 30.
(e) The home in which a child shall be determined in accordance with
Section 50374 when both of the following conditions exist:
(1) The child stays alternately for periods of one month or less with
each of his/her parents.
(2) The child's parents are separated or divorced.
(f) An 18 to 21 year old or unmarried minor parent living on the par-
ent's property shall not be considered to be living in the parent's home
if both of the following conditions exist:
(1) The 18 to 21 year old or unmarried minor parent does not receive
any support from the parents.
(2) The building the 18 to 21 year old or unmarried minor parents lives
in would be considered other real property of the parents.
Page 314
Register 97, No. 50; 12-12-97
Title 22
Health Care Services
§ 50076
(g) A person whose institutional status results in ineligibility for
Medi-Cal shall not be considered to be living in the home during any full
month of institutionalization.
Note-. Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14008 and 14051, Welfare and Institutions Code.
History
1 . Amendment filed 1-8-81 ; effective thirtieth day thereafter (Register 81 , No. 2).
2. Amendment of subsection (c) filed 2-11-82; effective thirtieth day thereafter
(Register 82, No. 7).
3. New subsection (f) filed 4-1-83; effective thirtieth day thereafter (Register 83,
No. 14).
4. Amendment of subsection (d), relettering of former subsections (e) and (f) to
subsections (f) and (g) and new subsection (e) filed 4-17-89; operative
5-17-89 (Register 89, No. 48).
§ 50071 .5. Prepaid Health Plan.
(a) Prepaid health plan means any health care service plan as defined
in Health and Safety Code Section 1345 (0 which:
(1) Is licensed as a health care service plan by the Commissioner of
Corporations pursuant to the Knox-Keene Health Care Service Plan Act
of 1975, Chapter 2.2, commencing with Section 1340, Division 2, Health
and Safety Code, or has an application for licensure pending and was reg-
istered under the Knox-Mills Health Plan Act prior to its repeal in Chap-
ter 941, Statutes of 1975.
(2) Meets the requirements for participation in the Medicaid Program,
Title XIX of the Social Security Act, on an at risk basis.
(3) Has a contract with the Department to furnish directly or indirectly
health services to Medi-Cal beneficiaries on a predetermined periodic
rate basis.
(b) The term "prepaid health plan" does not include any pilot program
contract entered into pursuant to Article 7, commencing with Section
14490, Chapter 8, Part 3, Division 9, Welfare and Institutions Code.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14016.5, Welfare and Institufions Code.
History
1. New section filed 8-8-80; effective thirtieth day thereafter (Register 80, No.
32).
§ 50071.6. Prepaid Health Plan — Comprehensive.
Comprehensive prepaid health plan means a prepaid health plan that
is required by contract with the Department to provide the full scope of
benefits available under the Medi-Cal program.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14016.5, Welfare and Institutions Code.
History
1. New section filed 8-8-80; effective thirtieth day thereafter (Register 80, No.
32).
§ 50071 .8. Primary Care Case Management (PCCM) Plan.
Primary care case management plan or PCCM plan means any person
or organization who:
(a) Has entered into a contract with the Department on a capitated or
risk sharing basis, or both, to provide or arrange for the provision of
health care services under the provisions of Article 2.9 commencing with
section 14088, Welfare and Institutions Code; and
(b) Meets the requirements for participation in the Medicaid Program,
as stated in Title XIX of the Social Security Act, on an at-risk basis.
NOTE: Authority cited: Sections 10725, 14105 and 14124.5, Welfare and Institu-
tions Code. Reference: Sections 14088, 14088. 16 and 14088.2, Welfare and Insti-
tutions Code.
History
1 . New section filed 3-9-90 as an emergency, operafive 3-9-90 (Register 90, No.
12). A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on 7-9-90.
2. New section refiled 7-9-90 as an emergency; operative 7-9-90 (Register 90,
No. 35). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed by operation of law on 1 1-6-90.
3. Request to readopt section on an emergency basis pursuant to Government Code
section 1 1346. 1 granted and filed 1 1-6-90 as an emergency; operative 1 1-6-90
(Register 91, No. 6). A Certificate of Compliance must be transmitted to OAL
by 3-6-91 or emergency language will be repealed by operafion of law on the
following day.
4. Certificate of Compliance as to 1 1-6-90 order transmitted to OAL 2-22-91;
disapproved by OAL on 3-25-91 (Register 91, No. 1 8).
5. New section filed 3-25-91 as an emergency; operative 3-25-91 (Register 91,
No. 1 8). A Certificate of Compliance must be transmitted to OAL by 7-23-91
or emergency language will be repealed by operation of law on the following
day.
6. Certificate of Compliance as to 3-25-91 order including amendment of section
transmitted to OAL 7-19-91 and filed 8-19-91 (Register 92, No. 1).
§ 50072. Property — Community.
Community property means property acquired by either spouse during
marriage, unless the property was acquired as separate property or with
funds that can be identified as separate property.
NOTE; Authority cited: Secfions 10725 and 14124.5, Welfare and Institutions
Code. Reference: Secfions 14006 and 14008, Welfare and Institutions Code.
History
1. Editorial correction adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 50073. Property— Personal.
Personal property means possessions or interests, exclusive of real
property, that may be easily transported or stored; including but not lim-
ited to cash on hand, bank accounts, notes, mortgages, deeds of trust, cash
surrender value of life insurance, motor vehicles, uncollected judgments,
an interest in a firm in receivership, a lawsuit, patents and copyrights.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14006, Welfare and Insfitutions Code.
History
1 . Editorial correction adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 50074. Property— Real.
Real property means land and improvements which generally includes
any immovable property attached to the land and any oil, mineral, timber
or other rights related to the land.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Insfitutions
Code. Reference: Secfion 14006, Welfare and Institutions Code.
History
1. Editorial correction adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 50075. Property— Separate.
(a) Separate property means any item that is considered separate prop-
erty under California Property Law. Generally, separate property is prop-
erty acquired by an individual by any method prior to marriage, after ob-
taining an interlocutory or final judgment of dissolution, or while
voluntarily separated; or at any time by gift or inheritance, or purchases
made with funds that are separate property or with funds from the sale of
separate property.
(b) Separate property also includes that portion of a couple's former
community property which has been transmuted into separate property
by a written interspousal agreement in accordance with 50403(c).
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Insfitutions
Code. Reference: Secfions 14006, 14006.2 and 14008, Welfare and Institutions
Code.
History
1 . Editorial correction adding NOTE filed 7-7-83 (Register 83, No. 29).
2. New subsection (b) filed 2-16-88 as an emergency; operative 2-16-88 (Regis-
ter 88, No. 1 0). A Certificate of Compliance must be transmitted to OAL within
120 days or emergency language will be repealed on 6-15-88.
3. New subsection (b) refiled 6-1 6-88 as an emergency; operative 6-1 6-88 (Reg-
ister 88, No. 26). A Certificate of Compliance must be transtnitted to OAL with-
in 120 days or emergency language will be repealed on 10-14-88.
4. Emergency language of subsection (b) refiled and operafive 6-16-88 repealed
on l(>^]4-88 by operation of Government Code Section 1 1346.1 (Register 88,
No. 49).
5. New subsection (b) filed 1 1-16-88; operative 1 1-16-88 pursuant to Govern-
ment Code Secfion 11346.2(d) (Register 88, No. 49).
§ 50076. Property— Share of Community.
For the purpose of determining Medi-Cal eligibility, share of commu-
nity property is to be treated as if each spouse owns one-half of the com-
munity property.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Insfitutions
Code. Reference: Section 14006, Welfare and Institufions Code.
Page 315
Register 97, No. 50; 12-12-97
§ 50077
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
History
1 . Amendment filed 2-1 1-82; effective thirtieth day thereafter (Register 82. No.
7).
§ 50077. Public Agency.
Public agency means an administrative division of local, state or feder-
al government, or an organization that has a contract to act in behalf of
the local, state or federal government.
§ 50078. Public Assistance (PA) Recipient.
Public assistance (PA) recipient means a person or family receiving
assistance under the AFDC, SSI/SSP, Indochinese refugee or Cuban ref-
ugee program.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.1 and 14050.1, Welfare and Institutions Code.
History
1. Amendment filed 8-7-78; effective thirtieth day thereafter (Register 78, No.
32).
2. Amendment filed 7-31-81 as an emergency; effective upon filing (Register 81 ,
No. 33). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 1 1-28-81.
3. Certificate of Compliance transmitted to OAL 1 1-6-81 and filed 1-27-82
(Register 82, No. 5).
§ 50079. Public Funds.
Public funds means monies provided by local, state or federal govern-
ment.
§ 50079.5. Publicly Operated Community Residence.
(a) Publicly operated community residence means a facility designed
and planned to serve no more than 16 residents which is actually serving
16 or fewer residents. The facility provides food and shelter and must
provide some additional services such as:
(1) Social services.
(2) Help with personal activities.
(3) Training in socialization and life skills.
(b) Excluded from this definition are:
(1) Residential facilities located on the grounds or immediately adja-
cent to any large institution or multi-purpose complex.
(2) Educational or vocational training facilities.
(3) Correctional or holding facilities for persons detained under the pe-
nal system.
(4) Medical treatment facilities.
Note; Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 11014, 11016 and 14053, Welfare and Institutions
Code.
History
1. New section filed 4-1-83; effective thirtieth day thereafter (Register 83, No.
14).
§ 50079.6. Qualified Disabled and Working Individual.
"Qualified Disabled and Working Individual" ineans an individual
who meets the eligibility criteria for the Qualified Disabled and Working
Individual program specified in Section 50256.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; and Section 12, Chapter 1430, Statutes of 1989. Reference: Section
14005.3, Welfare and Institutions Code; and Sections 1396a(a)(10)(E) and
1396d(s), Title 42, United States Code.
History
1. Renumbering of former section 50079.6 to section 50079.7 and new section
filed 10-3-94 as an emergency; operafive 10-3-94 (Register 94, No. 40). A
Certificate of Compliance must be transmitted to OAL by 1 -31-95 or emergen-
cy language will be repealed by operation of law on the following day. For prior
history, see Register 91, No. 8.
2. Editorial correction of History Note 1 (Register 95, No. 9).
3. Reinstatement of section as it existed prior to emergency filed 3-2-95 by opera-
tion of Government Code secfion 1 1346.1(f) (Register 95, No. 9).
4. Renumbering of former secdon 50079.6 to section 50079.7 and new section re-
filed 3-3-95 as an emergency; operative 3-3-95 (Register95, No. 9). A Certifi-
cate of Compliance must be transmitted to OAL by 7-1-95 or emergency lan-
guage will be repealed by operation of law on the following day.
5. Certificate of Compliance as to 3-3-95 order including amendment of Note
transmitted to OAL 2-22-95 and filed 4-5-95 (Register 95, No. 14).
§ 50079.7. Qualified Medicare Beneficiary.
"Qualified Medicare Beneficiary" ineans an individual who meets the
eligibility criteria for the Qualified Medicare Beneficiary program speci-
fied in Section 50258.
NOTE; Authority cited: Sections 10725, 14005.1 1 and 14124.5, Welfare and Insfi-
tutions Code; and Section 12. Chapter 1430, Statutes of 1989. Reference: Section
]396d(p), Title 42, United States Code; and Section 14005.1 1, Welfare and Insti-
tutions Code.
History
1 . Renumbering of former section 50079.6 to new section 50079.7 filed 10-3-94
as an emergency; operative 10-3-94 (Register 94, No. 40). A Certificate of
Compliance must be transmitted to OAL by 1-31-95 or emergency language
will be repealed by operation of law on the following day.
2. Editorial correction of History Note 1 (Register 95, No. 9).
3. Repealed by operation of Government Code section 11346.1(2) (Register 95,
No. 9).
4. Renumbering of former section 50079.6 to section 50079.7 and new section re-
filed 3-3-95 as an emergency; operative 3-3-95 (Register 95. No. 9). A Certifi-
cate of Compliance must be transmitted to OAL by 7-1-95 or emergency lan-
guage will be repealed by operation of law on the following day.
5. Certificate of Compliance as to 3-3-95 order transmitted to OAL 2-22-95 and
filed 4-5-95 (Register 95, No. 14).
§ 50080. Quality Control.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14016(b), (d) and (e)(1) and 14100.1, Welfare and In-
stitutions Code.
History
1. Repealer filed 7-6-83 as an emergency; effective upon filing (Register 83, No.
33). A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on 11-3-83.
2. Certificate of Compliance u-ansmitted to OAL 1 1-3-83 and filed 2-6-83 (Reg-
ister 83, No. 50).
3. Corrected Certificate of Compliance as to 7-6-83 order filed 1-9-84 (Register
84, No. 2).
§50081. Reapplication.
Reapplication means an application for Medi-Cal-only eligibility
made in the same county as a previous application, if the previous appli-
cation was denied or withdrawn, or Medi-Cal-only eligibility based on
the previous application has been discontinued for more than 12 months.
History
1. Amendment filed 8-7-78; effective thirtieth day thereafter (Register 78, No.
32).
§ 50082. Recipient.
Recipient means a person or family receiving aid under a public assis-
tance program or the Other Public Assistance program.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.1 and 14050.1, Welfare and Insfitutions Code.
History
1. Editorial con-ection adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 50083. Redetermination.
Redetermination means the review of a person's or family's Medi-Cal
eligibility.
§ 50084. Relative.
Relative means a mother, father, grandfather, grandmother, son,
daughter, brother, sister, stepfather, stepmother, stepbrother, stepsister,
uncle, aunt, first cousin, nephew, niece, half-brother, half-sister, any
such person of a preceding or succeeding generation denoted by a prefix
of grand, great or great-great or the suffix in-law.
NOTE: Authority cited: Secfions 10725, 14006.1 and 14124.5, Welfare and Insti-
tutions Code. Reference: Sections 14005.7, 14006 and 14008, Welfare and Institu-
tions Code.
History
1. Editorial cortection adding NOTE filed 7-7-83 (Register 83, No. 29).
2. Amendment filed 12-2-85 as an emergency; effective upon filing (Register 85,
No. 50). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 4-1-86.
3. Certificate of CompUance transmitted to OAL 3-31-86 and filed 4-30-86
(Register 86, No. 18).
§ 50085. Relative— Caretaker.
Caretaker relative means a relaUve who provides care and supervision
to a child, if there is no naharal or adopUve parent in the home.
Page 316
Register 97, No. 50; 12-12-97
Title 22
Health Care Services
§ 50094
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14005.7, Welfare and Institutions Code.
History
1 . Editorial correction adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 50086. Repayment.
Repayment means the liquidation of an overpayment in response to is-
suance of demands and recovery thereof by the Department of Benefit
Payments.
§ 50087. Residence.
Residence means the place in which a person or family lives oris phys-
ically present if the person or family has no present intention of leaving.
NOTE; Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14007 and 14016, Welfare and Institutions Code.
History
1. Editorial correction adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 50088. Responsible Relative.
Responsible relative means a relative who is responsible to contribute
to the cost of health care services received by a Medi-Cal beneficiary.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14008, 14008.5, 14009 and 14010, Welfare and Institu-
tions Code.
History
1. Editorial correction adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 50089. Restoration.
Restoration means the approval of Medi-Cal-only eligibility for a
person or family in the same county as that in which they were previously
ehgible for Medi-Cal-only, if the effective date of the approval occurs
within 12 months of the end of the previous period of eligibility.
History
1. Amendment filed 8-7-78; effective thirtieth day thereafter (Register 78, No.
32).
§ 50090. Share of Cost.
Share of cost means a person' s or family ' s net income in excess of their
maintenance need that must be paid or obligated toward the cost of health
care services before the person or family may be certified and receive
Medi-Cal cards.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.9 and 14054, Welfare and Institutions Code.
History
1. Editorial correction adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 50091 . Share of Encumbrances.
Share of encumbrances means that portion of the encumbrances attrib-
uted to each portion of jointly owned property.
§ 50091 .5. Specified Low-Income Medicare Beneficiary.
"Specified Low-Income Medicare Beneficiary" (SLMB) means an
individual who meets the eligibility criteria for the SLMB Program speci-
fied in Section 50258.1.
NOTE: Authority cited: Sections 10725 and 14124,5 of the Welfare and Institu-
tions Code. Reference: Section 1396a(a)(l 0)(E)(iii), Title 42, United States Code.
Hjstory
1. New section filed 12-21-93; operative 1-20-94 (Register 93, No. 52).
§ 50092. Spenddown.
Note: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; and Section 57(c), Chapter 328, Statutes of 1982. Reference: Section
14019.6, Welfare and Institutions Code.
History
1 . Repealer filed 8-1 8-82 as an emergency; effecdve upon filing (Register 82, No.
34). A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on 12-16-82.
2. Certificate of Compliance transmitted to OAL 12-14-82 and filed 1-21-83
(Register 83, No. 4).
§ 50093. State Data Exchange (SDX).
State Data Exchange (SDX) means the data system by which the Fed-
eral Government provides information to the State regarding the eligibil-
ity of SSI/SSP applicants and recipients.
Note: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Secfion 14017, Welfare and Institutions Code.
History
1. Editorial correcfion adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 50094. Stepparent.
Stepparent means a person who is married to the parent of a child and
who is not the other parent of the child.
[The next page is 317.]
Page 316.1
Register 97, No. 50; 12-12-97
Title 22
Health Care Services
§ 50101
•
NOTE; Authority cited; Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 1 1261, 14001.1 and 14005.7, Welfare and Institutions
Code.
History
1. Editorial correction adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 50095. Supplemental Security Income/State
Supplemental Program (SSI/SSP).
Supplemental Security Income/Slate Supplemental Program (SSI/
SSP) means the federal and state payinents, respectively, which are based
on need, and are paid to aged, blind or disabled persons.
§ 50095.1. Title II Disregard Person.
NOTE; Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14005.7, Welfare and Institutions Code.
History
1 . New section filed 1-5-78 as an emersency; effective upon filing (Register 78,
No. 1).
2. Certificate of Compliance filed 5-5-78 (Register 78, No. 18).
3. Renumbering of Section 50095.1 to Section 50095.7 filed 8-9-85 as an emer-
gency; effective upon filing (Register 85, No. 32). A Certificate of Compliance
must be transmitted to OAL within 120 days or emergency language will be re-
pealed on 12-9-85.
4. Certificate of Compliance as to 8-9-85 order transmitted to OAL 1 1-1 3-85 and
filed 12-1 1-85 (Register 85, No. 50).
§ 50095.5. Therapeutic Wages.
(a) Therapeutic wages are wages earned by the individual when all of
the following conditions are met:
( 1 ) A physician who does not have a financial interest in the long-term
care facility in which the individual resides, and who is in charge of the
individual's case prescribes this work as therapy for the individual.
(2) The individual must be employed by the same long-term care facil-
ity in which he or she resides.
(3) The individual's employment does not displace any existing em-
ployees.
(4) The individual has resided in a long-term care facility continuous-
ly since September 1979.
NOTE; Authority cited: Secfions 10725, 14005. 13 and 14124.5, Welfare and Insn-
tutions Code. Reference: Section 14005.13, Welfare and Institutions Code.
History
1 . New section filed 8-9-85 as an emergency; effective upon filing (Register 85,
No. 32). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 12-9-85.
2. Certificate of Compliance transmitted to OAL 11-13-85 and filed 12-11-85
(Register 85, No. 50).
§ 50095.7. Title II Disregard Person.
'Title II disregard person" means a person who meets all the condi-
tions of Section 50564.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14005.7, Welfare and Institutions Code.
History
1 . Renumbering of Section 50095.1 to Section 50095.7 filed 8-9-85 as an emer-
gency; effective upon filing (Register 85, No. 32). A Certificate of Compliance
must be transmitted to OAL within 120 days or emergency language will be re-
pealed on 12-9-85. For prior history, see Registers 78, No. 18, and 78, No. 1 .
2. Certificate of Compliance transmitted to OAL 11-13-85 and filed 12-11-85
(Register 85, No. 50).
§ 50096. Transfer of Property.
Transfer of property means a change in ownership whereby a person
no longer holds title to, or beneficial interest in, property.
NOTE; Authority cited: Sections 10725 and 14124.5, Welfare and Insfitutions
Code. Reference: Secfions 14006 and 14015, Welfare and Insfitutions Code.
History
1. Editorial correcfion adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 50097. Verification.
Verification means the process of obtaining acceptable evidence
which substantiates statements made by an applicant/beneficiary.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Insfitufions
Code; and Section 57, Chapter 328, Statutes of 1982. Reference: Section 1401 1,
Welfare and Institutions Code.
History
1 . New section filed 8-1 8-82 as an emergency; effective upon filing (Register 82.
No. 34). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 12-16-82.
2. Certificate of Compliance transmitted to OAL 12-14-82 and filed 1-21-83
(Register 83, No. 4).
Article 2. Administration
§ 50101 . County Department Responsibilities.
(a) The county department shall:
(1 ) Be responsible for determining initial and continuing eligibility for
Medi-Cal applicants or beneficiaries promptly and humanely, in accor-
dance with:
(A) Medi-Cal regulations.
(B) Departmental directives.
(2) Construe Medi-Cal regulations fairly and equitably when deter-
mining Medi-Cal eligibility.
(3) Have available at each office copies of all laws, rules, regulations
and bulletins relating to Medi-Cal.
(4) Comply with state hearing decisions of the Director.
(5) Assist applicants or beneficiaries in understanding their rights and
responsibilities in relation to application for Medi-Cal.
(6) Evaluate the capacity of the applicants or beneficiaries to discharge
their responsibilities as set forth in these regulations.
(7) Assist applicants or beneficiaries as needed in establishing their
eligibility.
(8) Determine eligibility, assess need, and authorize personal care pro-
gram services for eligible beneficiaries, as needed.
(b) The county department shall take the following actions whenever
an applicant or beneficiary, who is applying for or receiving Medi-Cal
on behalf of a child under eighteen years of age who was born out of wed-
lock or who has an absent parent, meets his/her responsibilities as speci-
fied in Section 50185 (a) 10.
(1) As soon as possible after the applicant's or beneficiary's opportu-
nity to claim good cause as specified in 50771.5, and not later than two
working days after approval of eligibility, the county shall provide to the
district attorney the following forms, whether or not the Child/Spousal
and Medical Support Notice and Agreement (CA 2. 1 Notice and Agree-
ment) has been completed;
(A) A completed Referral to District Attorney (CA 371, Revised De-
cember 1992)
(B) A Child Support Questionnaire (CA 2.1 Q Support Questionnaire,
Revised March 1993), if one has been completed;
(C) Health Insurance Questionnaire (DHS 6155, Revised October
1990), if one has been completed.
(D) Any other forms or informafion requested by the district attorney.
(2) If the referral described in (1) above has previously been provided
to the district attorney, the county shall promptly report to the district at-
torney whenever good cause has been claimed. The district attorney will
suspend all acfivities to establish paternity or secure medical support un-
til notified of a final determination of good cause by the county.
(3) The county shall promptly report to the district attorney all cases
in which it has been determined that there is or is not good cause for refus-
al to cooperate as specified in Section 50771 .5. The district attorney will
not undertake to establish paternity or secure support if there has been a
finding of good cause unless there also has been a determination by the
county that the district attorney may proceed without the participation of
the parent or caretaker relafive. If there has been such a determination,
the district attorney may undertake to establish paternity or secure sup-
port but may not involve the parent or caretaker relative.
(4) If the county determines that the applicant or beneficiary and the
child on whose behalf the application was filed are not eligible, the appli-
cant or beneficiary shall be informed that he/she may go to the district at-
torney for help in locating the absent parent(s) of the child, collecting
child and medical support for the child, and establishing paternity.
Page 317
Register 93, No. 39; 9-24-93
§ 50103
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
(5) The county shall provide the district attorney with any information
requested concerning medical support cases and shall advise the district
attorney in writing if any of the following circumstances arise:
(A) A person is added to or deleted from the MFBU.
(B) The child ceases living with the person who is receiving Medi-Cal
on his/her behalf.
(C) A child moves out of foster care and begins living with a parent or
relative.
(D) A child has been accepted for adoption by a public or private adop-
tion agency or such an acceptance has been terminated.
(E) Medi-Cal benefits have been discontinued.
(6) If the district attorney notifies the county that the applicant or bene-
ficiary has not cooperated, the county shall verify the facts, determine
whether he/she had good cause for failure to cooperate pursuant to Sec-
tion 50771.5, and notify the district attorney of the determination.
(7) Prior to making a final determination of good cause for refusing to
cooperate, the county shall:
(A) Afford the district attorney the opportunity to review and comment
on the findings and basis for the proposed determination;
(B) Consider any recommendation from the district attorney; and from
any witnesses on behalf of the applicant in any hearing that results from
an applicant' s or beneficiary' s appeal of any county action relating to es-
tablishing paternity or securing medical support.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 10000, 10058, 10747, 10800. 10963, 11000, 11490,
14008.6 and 14016, Welfare and Institutions Code; and 42 C.F.R. Sections
433.135, 433.136, 433.137, 433.138, 433,145, 433.146, 433.147, 433.148 and
435.604.
History
1. Amendment filed 5-30-80 as an emergency; effective upon filing (Register 80,
No. 22). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 9-27-80.
2. Certificate of Compliance filed 9-26-80 (Register 80, No. 39).
3. Amendment of subsection (a)(2) filed 3-25-83; effective thirtieth day thereafter
(Register 83, No. 13).
4. Editorial correction of Note filed 7-7-83 (Register 83, No. 29).
5. New subsection (a)(8) filed 4-14-93 as an emergency; operative 4-14-93. Sub-
mitted to OAL for printing only pursuant to section 8, AB 1773 (Chapter 939,
Statutes of 1992) (Register 93, No. 16).
6. New subsections (b)-(b)(7)(B) and amendment of Note filed 4-16-93 as an
emergency; operative 4-16-93 (Register 93, No. 16). A Certificate of Com-
pliance must be transmitted to OAL 8-16-93 or emergency language will be re-
pealed by operation of law on the following day.
7. Certificate of Compliance as to 4-16-93 order including amendment of subsec-
tion (b)(1)(C) and Note transmitted to OAL 8-1 3-93 and filed 9-23-93 (Reg-
ister 93, No. 39).
§ 501 03. Civil Service or Merit Systems.
All persons employed by a county and engaged in adininistration of
the Medi-Cal program shall be employed under a civil service or merit
system that meets the requirements established by the California State
Personnel Board.
§50105. Staffing Requirements.
(a) Medi-Cal eligibility services may be provided by personnel in
those technical nonsocial work job classifications that are established by
the county personnel agency responsible for approving such job classifi-
cation.
(b) The county department shall assign Medi-Cal eligibility staff in
sufficient numbers so that any applicant or beneficiary in need of eligibil-
ity services shall be provided with those services.
(c) Eligibility information shall be available 24 hours a day, 7 days a
week, to persons with medical and related emergencies.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institudons
Code. Reference: Sections 10809 and 14(X)1, Welfare and Institutions Code.
History
1. Editorial con-ection adding NOTE filed 7-7-83 (Register 83, No. 29).
§50106. Staff Training.
The county department shall train Medi-Cal eligibility staff in accor-
dance with the training requirements of Division 14, Manual of Policies
and Procedures, Department of Social Services.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 10800, 10820, 10900, 10906 and 14001, Welfare and
Institutions Code.
History
1. Editorial corteciion filed 7-7-83 (Register 83, No. 29).
§50107. Civil Rights.
(a) The county department shall not discriminate against any applicant
or beneficiary on the basis of race, color, creed, ethnic origin, sex, marital
status, age, physical or mental handicap, national origin or political affili-
afion.
(b) Persons who believe that they have been discriminated against may
file a grievance with the Department in accordance with departmental
procedures.
§50109. Reports.
The county department shall submit reports as required by the Depart-
ment and shall comply with such provisions as the Department may find
necessary to ensure the correctness of the reports.
§50110. Medi-Cal Case.
(a) Each MFBU shall be one Medi-Cal case.
(b) Each Other PA person or Other PA family group shall be one
Medi-Cal case.
(c) A PA recipient or PA family group shall not be a Medi-Cal case.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005 and 14008, Welfare and Institutions Code.
History
1. Editorial correction adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 501 1 1 . Case Records and Confidentiality.
(a) The county department shall adhere to the requirements in Divi-
sions 19 and 23, Manual of Policies and Procedures, Department of So-
cial Services, governing:
(1) Maintenance of case records.
(2) Confidentiality of case records.
(3) Safeguarding federal tax information.
(4) Access to case records.
(b) The board of supervisors of a county may authorize the destruction
of:
(1) Narrative portions of a case record which are over three years old
in any case file, active or inactive, after audit by the county department.
(2) Case files which have remained inactive for a period of three years
providing the Department has not notified the county department that un-
resolved issues or pending civil or criminal actions exist.
NOTE: Authority cited: Sections 10725, 10740 and 14124.5, Welfare and Institu-
tions Code. Reference: Sections 10850-10853, 14001 and 14100.2, Welfare and
Insfitutions Code; and 42 Code of Federal Regulations, 431.300 and 431.305.
History
1 . Amendment filed 3-7-80; effective thirtieth day thereafter (Register 80, No. 9).
2. Amendment of subsection (a) filed 7-16-87; operative 7-16-87 pursuant to
Government Code Section 1 1346.2(d) (Register 87, No. 30).
§50113. Forms.
(a) The county department shall use the forms prescribed by the De-
partment in providing Medi-Cal eligibility services.
(b) Other forms shall not be substituted by the county department un-
less specifically approved by the Department.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 10820, 1085, 1 1050, 14001 and 1401 1 , Welfare and In-
stitutions Code.
History
1. Editorial con-ection adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 501 1 5. Quality Control — County Cooperation.
The county department shall cooperate with the Department in ensur-
ing that federal quality control requirements are met.
Page 318
Register 93, No. 39; 9-24-93
Title 22 Health Care Services § 50116
§ 501 1 6. Medi-Cal Fiscal Penalties. Department staff of a random sample of a minimum number of cases for
(a) TTie Department shall assess fiscal penalties to counties whenever each period, as follows:
the state dollar error rate exceeds the federal standard. (1) All cases shall be sampled in any county with less than 50 Medi-
(b) A county's case error rate shall be determined based on reviews by Cal cases.
[The next page is 319.]
Page 318.1 Register 93, No. 39; 9-24-93
Title 22
Health Care Services
§ 50118.5
•
(2) Fifty cases in any county with greater than O.OJ percent and less
than or equal to 0.50 percent of the Medi-Cal cases in the state.
(3) Seventy-five cases in any county with greater than 0,50 percent
and less than or equal to 1 .0 percent of the Medi-Cal cases in the state.
(4) One hundred cases in any county with greater than 1.0 percent and
less than or equal to 3.0 percent of the Medi-Cal cases in the slate.
(5) One hundred twenty-five cases in any county with greater than 3.0
percent and less than or equal to 10.0 percent of the Medi-Cal cases in
the state.
(6) Six hundred fifty cases in any county with greater than 10.0 percent
of the Medi-Cal cases in the state.
(c) Medi-Cal fiscal penalties established under this Section shall ap-
ply only to those counties for which case error rates are established.
(d) The Department shall determine which counties in the state are h-
able for fiscal penalties as follows:
(1) The 60 percent of counties in the state with the highest case error
rates shall be liable if the state's dollar error rate exceeds the federal stan-
dard by 0.01 percent to 1.0 percent.
(2) The 70 percent of counties in the state with the highest case error
rates shall be liable if the state's dollar error rate exceeds the federal stan-
dard by greater than 1.0 percent and less than or equal to 2.0 percent.
(3) The 80 percent of counties in the state with the highest case error
rates shall be liable if the state's dollar error rate exceeds the federal stan-
dard by greater than 2.0 percent and less than or equal to 3.0 percent.
(4) The 90 percent of counties in the state with the highest case error
rates shall be liable if the state's dollar error rate exceeds the federal stan-
dard by greater than 3.0 percent and less than or equal to 4.0 percent.
(5) All counties in the state shall be liable if the state's dollar error rate
exceeds the federal standard by greater than 4.0 percent.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14016(c), (e) and (g), Welfare and histitutions Code.
History
1. New section filed 7-6-83 as an emergency; effective upon filing (Register 83,
No. 33). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 1 1-3-83.
2. Certificate of Compliance transmitted to OAL 11-3-83 and filed 12-6-83
(Register 83, No. 50).
3. Corrected Certificate of Compliance as to 7-6-83 order filed 1-9-84 (Register
84, No. 2).
4. Amendment filed 5-15-92; operafive 6-15-92 (Register 92, No. 21).
§ 50116.5. Appeal of Quality Control Review Findings.
(a) When the Department finds a sampled case that includes an ineligi-
ble person or a person with an understated share of cost, written notifica-
tion which describes the error shall be sent to the county department.
(b) Tlie county department shall respond to the Department in writing
within two weeks from receipt of notification of the error and shall indi-
cate whether it agrees or disagrees with the findings.
(c) If the county disagrees, the Department shall reevaluate the error
findings, taking into consideration any additional facts contained in the
county's response.
(d) The Department shall again notify the county of the Department's
findings.
(e) The county may then appeal to the Chief, Medi-Cal Policy Divi-
sion, requesting that the Department review the case and render a final
decision.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14016(f), Welfare and Institufions Code.
History
1. New section filed 5-15-92; operafive 6-19-92 (Register 92, No. 21).
§ 501 1 7. Calculation of Medi-Cal Fiscal Penalties.
(a) The Department shall calculate the fiscal penalty for a liable county
for each monitoring period as follows:
(1) A penalty multiple shall be calculated by multiplying a county's
case error rate times its percentage of statewide Medi-Cal cases.
(2) A county's penalty multiple shall be divided by the sum of the pen-
alty multiples of all counties then multiplied times the penalty bank.
(b) The penalty bank shall include only quality control federal fiscal
sanctions, federal withholds, federal disallowances, and any associated
General Fund expenditures, minus the value of any state assumed errors
and the General Fund share of the value of client caused errors.
(c) The case error rate and penalty multiple shall be adjusted by ex-
cluding client errors for the purpose of determining the associated Gener-
al Fund expenditures.
(d) If the Federal Government reduces or eliminates any quality con-
trol federal fiscal sanction, federal withhold or federal disallowance as-
sessed a county as a penalty, the Department shall reduce or eliminate the
corresponding fiscal penalty assessment including any associated Gener-
al Fund expenditures to liable counties.
(e) The monitoring period shall be the federal fiscal year. Fiscal penal-
ties shall apply to the entire monitoring period. The first monitoring peri-
od shall begin October 1, 1988.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Insfitulions
Code. Reference: Secfion 14016(g), Welfare and Institutions Code.
History
1. New section filed 7-6-83 as an emergency; effective upon filing (Register 83,
No. 33). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 1 1-3-83.
2. Certificate of Compliance transmitted to OAL 11-3-83 and filed 12-6-83
(Register 83, No. 50).
3. Cortected Certificate of Compliance as to 7-6-83 order filed 1-9-84 (Register
84, No. 2).
4. Amendment filed 5-15-92; operative 6-15-92 (Register 92, No. 21).
§ 50118. Application of Medi-Cal Fiscal Penalties.
(a) The Department shall notify the county in writing when it deter-
mines that a Medi-Cal fiscal penalty will be imposed.
(b) The county may request reconsideration of the Medi-Cal fiscal
penalty in accordance with Section 50118.5.
(c) When a Medi-Cal fiscal penalty is imposed, the amount of the pen-
alty shall be collected through direct repayment.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14016(f) and (i). Welfare and Institutions Code.
History
1. New section filed 7-6-83 as an emergency; effective upon filing (Register 83,
No. 33). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 1 1-3-83.
2. Certificate of Compliance transmitted to OAL 11-3-83 and filed 12-6-83
(Register 83, No. 50).
3. Corrected Certificate of Compliance as to 7-6-83 order filed 1-9-84 (Register
84, No. 2).
4. Amendment filed 5-15-92; operafive 6-15-92 (Register 92, No. 21).
§ 50118.5. Reconsideration of a Medi-Cal Fiscal Penalty.
(a) A county may request reconsideration of a Medi-Cal fiscal penalty
if the county case error rate is caused by circumstances outside the con-
trol of the county. Such circumstances may include, but are not necessari-
ly limited to, the following:
(1) Natural disasters which contribute significantly to the county case
error rate.
(2) Work stoppages or other work activity beyond the control of the
county which has a significant adverse impact on the processing of
Medi-Cal eligibility cases.
(3) Failure by the Department to meet the minimum sample of cases
specified in Section 501 16.
(4) Such other occurrences as determined by the Director.
(b) The county shall have thirty days from the date of the Department' s
notice of fiscal penalty to file a written request for reconsideration with
the Director. The request shall be signed by the county department Direc-
tor and shall include a concise, detailed explanation of the basis for re-
questing reconsideration. The Director may, for good cause, extend the
time to sixty days for the county to submit a request for reconsideration.
(c) Based on all the available written mateiial, the Director shall ad-
dress a decision on reconsideration to the county, in writing, within sixty
days of receipt of the request.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Insfitulions
Code. Reference: Secfion 14016(f), Welfare and Insfitufions Code.
Page 319
Register 93, No. 16; 4-16-93
§ 50119
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
History
1 . New section filed 7-6-83 as an emergency; effective upon filing (Register 83,
No. 33). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 1 1-3-83.
2. Certificate of Compliance transmitted to OAL 11-3-83 and filed 12-6-83
(Register 83, No. 50).
3. Conected Certificate of Compliance as to 7-6-83 order filed 1-9-84 (Register
84, No. 2).
4. Amendment filed 5-15-92; operafive 6-15-92 (Register 92, No. 21).
§ 50119. County Corrective Action Requirements.
(a) The county shall correct a case found in error during the Depart-
ment's sample case review within thirty days after being notified of the
Department's final decision that a case error has occurred.
(b) A county whose case error rate is found to be in excess of fifteen
percent shall within 90 days of being notified by the Department of this
error rate provide a written report to the Department which shall describe
the steps the county has taken or plans to take to reduce or eliminate the
causes of error. The Department shall provide direction on the form and
content of the report and shall be responsible for approving the county's
Corrective Action Plan.
(c) The data collected on an individual county during the review con-
ducted by the Department shall be analyzed by the county to determine
causes of error. The county shall utilize this information in conjunction
with other information available to the county to develop and implement
correction actions which will reduce or eliminate the causes of error.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14016(h), Welfare and Institufions Code.
History
1. New section filed 7-6-83 as an emergency; effective upon filing (Register 83,
No. 33). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 1 1-3-83.
2. Certificate of Compliance transmitted to OAL 11-3-83 and filed 12-6-83
(Register 83, No. 50).
3. Corrected Certificate of Compliance as to 7-6-83 order filed 1-9-84 (Register
84, No. 2).
4. Amendment filed 5-15-92; operative 6-15-92 (Register 92, No. 21).
Article 3. County of Responsibility for
Determination of Medi-Cal Eligibility
§ 50120. County of Responsibility.
(a) The county of responsibility shall be the county whose county de-
partment is responsible for determining the initial and continuing Medi-
Cal eligibility for a person or family. The appropriate county of responsi-
bility shall be determined in accordance with the regulations in this
article.
(b) Disputes between counties regarding county of responsibility shall
be resolved by the Director.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 10806 and 14016, Welfare and Insfitutions Code.
History
1. Editorial correction adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 501 21 . Persons Eligible Under SSI/SSP.
The county of responsibility for determining Medi-Cal eligibility for
persons eligible under AFDC or SSI/SSP shall be established in accor-
dance with the regulations of the applicable public assistance program.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.1 and 14050.1, Welfare and Institutions Code.
History
1. Amendment filed 8-7-78; effective thirtieth day thereafter (Register 78, No.
32).
2. Amendment filed 7-31-81 as an emergency; effective upon filing (Register 81,
No. 33). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 11-28-81.
3. Certificate of Compliance transmitted to OAL 11-6-81 and filed 1-27-82
(Register 82, No. 5).
4. Editorial correction of section heading filed 7-7-83 (Register 83, No. 29).
§ 50123. County of Responsibility — Persons with a Family.
(a) The county of responsibility for determining Medi-Cal eligibility
for persons whose eligibility as MN, MI or Other PA is determined as part
of a family, or based on family income, shall be either of the following:
(1) The county in which the family's residence is located.
(2) The county of physical presence if the family's residence is un-
clear.
(b) The county of responsibility for determining Medi-Cal eUgibility
for a family which includes a person under age 21 or, through Deceinber
31, 1982, an Ml person, living away from the home and who is claimed
by his/her parent as a dependent in order to receive a tax credit or deduc-
tion for state or federal income tax purposes shall be the county in which
the claiming parent lives as determined in accordance with (a).
(c) The county of responsibility for determining Medi-Cal eligibility
for a person who is claimed by his/her parent as a dependent or as a de-
duction for tax purposes and whose parent lives out of state shall be the
county in which such person resides as determined in accordance with
(a).
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Institutions
Code; Section 57(c), Chapter 328, Statutes of 1982; and Section 87(c), Chapter
1594, Statutes of 1982. Reference: Sections 1 1050, 14005.4, 14005.7, 14008 and
14016(a) and (c), Welfare and Institutions Code.
History
1. New subsecfions (b) and (c) filed 10-1-82 as an emergency; effecfive upon fil-
ing (Register 82, No. 40). A Ceitificate of Compliance must be transmitted to
OAL within 120 days or emergency language will be repealed on 1-29-83.
2. Certificate of Compliance including editorial cortection of NOTE transmitted
to OAL 1-28-83 and filed 2-28-83 (Register 83, No. 10).
3. Editorial con-ection of NOTE filed 4-12-83 (Register 83, No. 16).
§ 50125. County of Responsibility — Persons with No
Family.
(a) The county of responsibility for determining Medi-Cal eligibility
for persons whose eligibihty as MN, MI or Other PA is not determined
as part of a family, nor based on family income, shall be:
(1) The placing county for:
(A) Persons placed by a county agency in a private or county-adminis-
tered facility in order to receive long-term care.
(B) Children placed by a county agency in foster or adoptive care un-
der Aid Codes 04, 43, 44, 45, 46 and 47.
(2) The county in which the person's home is located, if the person is
temporarily absent from the home as specified in Section 50071(a)(2).
(3) The county in which the person is living in all other situations.
NOTE: Authority cited: Sections 10725, 14006.1 and 14124.5, Welfare and Insti-
tutions Code. Reference: Secfions 11050, 14005.4, 14006, 14008 and 14016(a)
and (c). Welfare and Institutions Code.
History
1. Amendment of subsection (a)(1)(B) filed 12-15-77; effecfive thirtieth day
thereafter (Register 77, No. 51).
2. Amendment of subsections (a)(2) and (a)(3) filed 12-2-85 as ain emergency; ef-
fective upon filing (Register 85, No. 50). A Certificate of Compliance must be
transmitted to OAL within 1 20 days or emergency language will be repealed on
4-1-86.
3. Certificate of Compliance transinitted to OAL 3-31-86 and filed 4-30-86
(Register 86, No. 18).
§ 50126. County of Responsibility — Persons Eligible Under
Special Programs.
(a) The county of responsibility for determining Medi-Cal eligibility
for persons eligible under the Cuban Refugee, Indochine&e Refugee, and
Medi-Cal Dialysis Programs shall be:
(1) The county in which the person's residence is located.
(2) The county of physical presence if the person's residence is un-
clear.
(b) The county of responsibility for determining Medi-Cal eligibihty
for persons eligible under the MC 800 Program shall be the county which
owns the medical facility, or which has a contract with the hospital,
where health services are received.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Institutions
Code. Reference: Secfion 14016, Welfare and Institufions Code.
Page 320
Register 93, No. 16; 4-16-93
Title 22
Health Care Services
§ 50136
History
) . New section filed 3-7-80; effective thirtieth day thereafter (Register 80, No. 9).
§ 50127. Persons with a Guardian.
(a) The county of responsibility for persons with a county public
guardian shall be the county in which the public guardian is located ex-
cept that if the person is physically present in another county and the new
county will accept a transfer of guardianship, the new county shall be the
county of responsibility.
(b) The county of responsibility for persons with a private guardian or
persons with a guardian employed by the state shall be estabHshed as if
there were no guardian in accordance with Sections 50121, 50123 and
50129 through 50134, provided the ward is a resident of the State.
NOTE; Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 11050, 14001 and 14016, Welfare and Institutions
Code.
History
1 . Amendment filed 12-15-77; effective thirtieth day thereafter (Register 77, No.
51).
2. Editorial conection filed 7-7-83 (Register 83, No. 29).
§ 50129. County of Responsibility — Persons Placed In
State Hospitals by County Mental Health
Agencies or Regional Centers for the
Oevelopmentally Disabled.
Notwithstanding the requirements of any other section in this article,
the county of responsibility for determining Medi-Cal eligibility for per-
sons placed in state hospitals after screening and referral by a county
mental health agency or a regional center for the Developmentally Dis-
abled shall be the county in which the state hospital is located, unless the
person's eligibility is determined as part of a family or based on family
income. In this case the county of responsibility shall be determined in
accordance with Section 50123.
§ 50131 . Placement in Long-Term Care After Release from
a State Hospital.
(a) Notwithstanding the requirements of any other section in this ar-
ticle, the county of responsibility for determining Medi-Cal eligibility
for persons released from a state hospital and placed in a long-term care
facility shall be the county in which the long-term care facility is located,
with the following exceptions:
(1) If the person has a public guardian or conservator in the original
county of placement into the state hospital, then that county shall remain
the county of responsibility, unless the county in which the long-term
care facility is located agrees to accept guardianship or conservatorship
of the person.
(2) If the person' s eligibility is determined as part of a family or based
upon family income, then the county of responsibility shall be deter-
mined in accordance with Section 50123.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 11050, 14001 and 14016, Welfare and Institutions
Code.
History
1 . Amendment filed 3-7-80; effective thirtieth day thereafter (Register 80, No. 9).
2. Editorial correction filed 7-7-83 (Register 83, No. 29).
§ 50133. County of Responsibility — Deceased Persons.
The county of responsibility for determining Medi-Cal eligibility for
persons who are deceased shall be the county which would have been the
county of responsibility at the time of the person's death.
§ 50134. County of Responsibility — Persons Absent from
the State.
The county of responsibility for determining Medi-Cal eligibility for
persons who are absent from the State and retain California residence, in
accordance with Article 7 of these regulations, shall be the county which
would have been the county of responsibility prior to the person's ab-
sence from the State.
§ 50135. Application Made in County Other Than County of
Responsibility.
(a) The county in which a person applies for Medi-Cal shall accept the
application and a Statement of Facts from such person or family on behalf
of the county of responsibility. If a Statement of Facts cannot be obtained,
the county accepting the application shall provide information to the
county of responsibility for the latter county to locate the applicant.
(b) The information described above shall be forwarded to the county
of responsibility not later than 15 days from the date of application.
(c) The county in which a person applies may with the consent of the
applicant or beneficiary, choose to become the county of responsibility
for determining initial eligibility and initiating an intercounty transfer.
NOTE; Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 11050, 14001 and 14016, Welfare and Institutions
Code.
History
1. Editorial coirection adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 50136. Intercounty Transfer Procedure.
(a) An intercounty transfer shall be initiated if persons or families re-
ceiving Medi-Cal-only become the responsibility of a new county. The
transfer shall be accomplished in accordance with the following proce-
dure, as modified by Section 50138.
(1 ) The county department initiating the transfer shall inform the bene-
ficiary in writing of his/her responsibility to apply for a redetermination
of ehgibility in the new county of residence and, within 7 calendar days
of the date the county department learns of the change in county of re-
sponsibility, send the following to the county department in the new
county of responsibility:
(A) Two copies of the Notification of Transfer, Form ABCDM 21 5,
with Section A completed indicating the date of discontinuance deter-
mined in accordance with Section 50137.
(B) One copy of the most recently completed of each of the following
forms with the Notification of Transfer, Form ABCDM 215, or within
one week after this form is sent:
1. Application for PubHc Social Services, CA 1.
1. Statement of Fact, MC 210, MC 250 or CA 2.
3. Share of Cost Determination — MN and MI Person, MC 176M.
4. Allocation/Special Deduction Worksheet, MC 176W, if any.
5. Property Worksheet, MC 176P, if any.
6. Rights of Persons Requesting Medi-Cal, MC 216, if any.
7. Medi-Cal Responsibilities Checklist, MC 217, if any.
8. Verification of disability, if any.
9. Notification of Action, Utilization of Property, Form MC 239U, if
the person or family is within a six-month utilization period at the time
of transfer.
(C) The amount, if any, of a remaining adjustment for decreases in in-
come pursuant to Section 50653.3.
(D) Other information that the initiating county considers important in
order for the new county of responsibility to determine eligibility.
(2) The initiating county, if the person or family becomes the responsi-
bility of a third county during the transfer process, shall:
(A) Notify the former new county department that the transfer is can-
celled.
(B) Request the former new county department to forward to the
county department of the current new county of responsibility all infor-
mation and documents supplied by the initiating county and any addi-
tional information secured by the former new county.
(C) Send to the current new county department two copies of the Noti-
fication of Transfer, Form ABCDM 215, with Section A completed indi-
cating the date of discontinuance determined in accordance with Section
50137.
(3) The county department in the new county of responsibility shall:
Page 321
Register 2000, No. 38; 9-22-2000
§ 50137
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
(A) Perform a redetermination of eligibility if the conditions of Sec-
tion 50136 (a)(i) are met.
(B) Return to the initiating county department one copy of the Notifi-
cation of Transfer form, Form ABCDM 215, within 30 days of receipt of
the form. Section B shall be completed, indicating acceptance or refusal
of the transfer, and the effective date of eligibility, if eligibility is ap-
proved in the new county.
(C) Send a Notice of Action to the person or family, if their eligibihty
is approved. A Notice of Action must also be sent to the person or family
if eligibility is discontinued for failure to apply for a redetermination or
if the person or family is no longer eligible. Such action shall be effective
as established in accordance with Section 50137.
(4) If the Notification of Transfer form has not been returned within
30 days, the initiating county shall contact the new county to assure that
continuous Medi-Cal coverage will be provided to the extent that eligi-
bility exists.
NOTE; Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 1 1053 and 14016, Welfare and Institutions Code.
History
1. Amendment of subsection (a)(1)(B) filed 12-15-77; effective thirtieth day
thereafter (Register 77, No. 51).
2. Amendment filed 8-8-80; effective thirtieth day thereafter (Register 80, No.
32).
3. Editorial correction filed 7-7-83 (Register 83, No. 29).
4. Amendment filed 4-17-86: effective thirtieth day thereafter (Register 86, No.
16).
5. Change without regulatory effect of subsection (a)(1)(C) (Register 87, No. 11).
§ 50137. Intercounty Transfer — Effective Date of
Discontinuance/Eligibility.
(a) In a change in county of responsibihty, the effective date of discon-
tinuance as determined by the initiating county department shall be the
last day of the month in which the 30th day after notification to the new
county of the change in county of responsibihty occurs except that:
(1) If the initiating county department determines the person or family
is no longer eligible, the last day of the month in which the determination
of ineligibility is made, provided a 10-day notice is given or is waived.
Otherwise, discontinuance is effective on the last day of the month in
which the 1 0-day notice is given.
(2) If the person or family is receiving Medi-Cal under either the Four
Month or Nine Month Continuing Eligibility categories, the last day of
the final month in which four month or nine month continuing eligibility
exists.
(b) If the county department in the new county of responsibility deter-
mined that a person or family is eligible for Medi-Cal, the effective date
of eligibility shall be the first day of the month following the month in
which the initiating county department discontinues eligibility.
(c) Counties involved in an intercounty transfer may, by mutual agree-
ment, establish a different effective date of discontinuance, if the initiat-
ing county department can suppress card issuance for the following
month.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; Section 1 33.5, Chapter 1 02, Statutes of 1 98 1 ; and Section 14, Chapter 1 447,
Statutes of 1984. Reference: Sections 10740, 1 1053, 14005.8, 14005.9, 14016(a)
and 14100.1, Welfare and Institutions Code.
History
1 . Amendment of subsection (a)(2) filed 4-15-85 as an emergency; effective upon
filing (Register 85, No. 16). A Certificate of Compliance must be transmitted
to OAL within 120 days or emergency language will be repealed on 8-13-85.
For prior history, see Register 84, No. 24.
2. Certificate of Compliance as to 4-15-85 order transmitted to OAL 8-13-85 and
filed 9-18-85 (Register 85, No. 38).
§ 501 38. Intercounty Transfer — Blindness or Disability
Determination Pending.
(a) In a change of county of responsibility for persons or families who
have an application pending for either the SSI/SSP or MN programs on
the basis of blindness or disability, the responsibility shall be transferred
to the new county in accordance with the following:
(1) If the person or family is eligible for Medi-Cal at the time the
county of responsibility changes, responsibility shall be transferred in ac-
cordance with Sections 50136 and 50137.
(2) The pending determination of blindness or disabihty shall be re-
tained by the initiating county department until the blindness or disability
determination is received. The initiating county department shall for-
ward the blindness or disability determination, along with the documents
specified in Section 501 36 (a) (1) (B), within 14 calendar days of the date
the determination was received.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 11053. 14001 and 14016, Welfare and Institutions
Code.
History
1. Editorial con-ection adding NOTE filed 7-7-83 (Register 83. No. 29).
Article 4. Beneficiary Application Process
§ 50141. Application Process — General.
The county department shall receive and act upon all applications,
reapplications, requests for restoration and redeterminations without
delay and in accordance with the provisions of this article.
History
1. Change without regulatory effect amending article 4 heading filed 9-19-2000
pursuant to section 1 00, title 1 , California Code of Regulations (Register 2000,
No. 38).
§50142. Screening.
(a) County departments that have established a procedure for screen-
ing potential applicants prior to application shall:
(1) Determine the Medi-Cal program under which the person or fami-
ly should be processed.
(2) Provide information regarding Medi-Cal eligibility requirements
to all persons being screened.
(3) Inform each person being screened of that person' s rights under the
Medi-Cal program, even if it appears that the person is ineUgible. Rights
of Persons Requesting Medi-Cal, MC 216, shall be explained to, and
signed by, the person being screened.
(A) The original shall be retained by the county department. If the per-
son being screened does not apply for Medi-Cal, the form shall be re-
tained for at least 90 days.
(B) A copy shall be given to the person being screened.
§ 50143. Persons Who May File an Application for
Medi-Cal.
(a) Any person who wishes to receive Medi-Cal may file an applica-
tion. If the appUcant for any reason is unable to apply on his own behalf,
or is deceased, any of the following persons may file the application for
the applicant.
(1) The applicant's guardian or conservator or executor.
(2) A person who knows of the applicant's need to apply.
(3) A public agency representative.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 11050, 14001, 14005.4, 14005.7, 14016.1 and
14016.2, Welfare and Institutions Code.
History
1. Editorial correction adding NOTE filed 7-7-83 (Register 83, No. 29).
2. Amendment of subsection (a) filed 7-9-87; operative 8-8-87 (Register 87, No.
30).
§ 50145. Medi-Cal Application for Persons Applying for a
Cash Grant or In-Home Supportive Services.
(a) A person or family applying and approved for any public assistance
program as specified in Section 50227 or In-Home Supportive Services
shall not be required to submit a separate application for Medi-Cal.
Medi-Cal eligibility is established automatically.
(b) A person or family specified in (a) may also apply for retroactive
Medi-Cal in accordance with Section 50148.
NOTE: Authority cited: Sections 10725 and 14124.5. Welfare and Institutions
Code. Reference: Sections 12305, 12305.5, 14005.1, 14019, 14050.1 and
14051.5, Welfare and Institutions Code.
History
1 . Amendment filed 8-7-78; effective thirtieth day thereafter (Register 78, No.
32).
Page 322
Register 2000, No. 38; 9-22-2000
Title 22
Health Care Services
§ 50148
2. Amendment filed 7-31-8 1 as an emergency; effective upon filing (Register 8 1 ,
No. 33). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 1 i -28-81.
3. Certificate of Compliance transmitted to OAL 11-6-81 and filed 1-27-82
(Register 82, No. 5).
4. Amendment filed 7-9-87; operative 8-8-87 (Register 87, No. 30).
§ 50146. Medi-Cal Application for Persons Applying for
In-Home Supportive Services.
NOTE: Authority cited: Sections 10725 and 14124.5. Welfare and Institutions
Code. Reference: Sections 14005.1 and 12305, Welfare and Insfitutions Code.
History
1. Amendment filed 8-7-78; effective thirtieth day thereafter (Register 78, No.
32).
2. Repealer filed 7-9-87; operative 8-8-87 (Register 87, No. 30).
§ 50147. Application for Medi-Cal Only.
(a) A person or family applying for Medi-CaJ only shall submit a com-
pleted application form to the county department.
(b) The county department shall, within 30 days of receipt of a referral
from the Department pursuant to 50183.5, contact an ABD person in a
long-term care facility and assist the ABD person with the completion
of an application form for Medi-Cal-only.
(1) An application for Medi-Cal-only shall be completed when:
(A) The ABD person has been in long-term care for more than the
month of admission and is expected to remain in the facility for at least
30 days.
(B) The ABD person has nonexempt monthly gross income in excess
of $44.90.
(2) The county department shall advise the Department immediately
that an inappropriate referral has been received when the conditions in
(1) do not exist.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 1 1004, and 14016, Welfare and Institutions Code.
History
I. Amendment filed 4-13-81 ; effective thirtieth day thereafter (Register 81, No.
16).
§ 501 47.1 . Child Applying for Medi-Cal.
(a) A child may apply for Medi-Cal without parental contact in order
to receive minor consent services.
(b) A child applying on the basis of a need for minor consent services
other than mental health care shall submit to the county welfare depart-
ment a completed and signed form Request for Eligibility for Limited
Services indicating the need for services related to one or more of these
needs.
(c) A child applying for Medi-Cal solely on the basis of a need for
mental health care shall submit to the county welfare department a state-
ment from a mental health professional: licensed marriage, family and
child counselor; licensed educational psychologist; credentialed school
psychologist; clinical psychologist; or a licensed psychologist which
states that the child needs mental health treatment or counseling and
meets both of the following conditions:
(1) Is mature enough to participate intelligently in the mental health
treatment or counseling on an outpatient basis.
(2) Is one of the following:
(A) In danger of causing serious physical or mental harm to self or oth-
ers without mental health treatment or counseling.
(B) The alleged victim of incest or child abuse.
(d) The county department shall process the applications of children
applying under (b) and (c) in accordance with the following:
( 1 ) If a child refuses to complete or sign the form or provide a statement
of need for mental health care the child's application shall be denied.
(2) If a child is not competent to complete or sign the form, the person
completing the Statement of Facts in accordance with Section
50163(a)(2) and (3) may sign the form on the child's behalf.
(3) After submission of the completed and signed form or statement
of need for mental health care, the county department shall:
(A) Deny the application if a child is under 12 years of age and apply-
ing for services related to drug abuse, alcohol abuse, venereal disease or
a sexually transmitted disease or for mental health care.
(B) Issue POE labels under the child's existing Medi-Cal status if the
child is currently included in a public assistance case or an MFBU which
has no share of cost and is not enrolled in a PHP or PCCM plan. The
child's separate application shall be denied.
(C) Deny the application if the child is currently eligible for Medi-Cal
and enrolled in a PHP or PCCM plan and refer the child to the PHP or
PCCM plan for care.
(D) Process the application and determine eligibility if the child is one
of the following:
1. Currently included in an MFBU which has a share of cost.
2. Part of a family not currently receiving Medi-Cal.
3. Excluded from an MFBU.
4. An ineligible member of an MFBU.
(E) If the child is an unmarried minor parent, he/she shall be included
in the MFBU with his/her child for minor consent services only.
(e) When a child is not living with the child's parents and county de-
partment determines that no person or agency accepts legal responsibility
for the child, the county department shall process the child's application
and determine his or her eligibility as an adult if the child appears to be
competent.
(f) The parents of a child applying in accordance with (b) or (c) shall
neither be contacted regarding the child's application nor informed that
the application has occurred.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.1. 14005.4, 14005.7, 14008, 14008.5, 14010,
14011, 14017, 14018, and 14088.3, Welfare and Institutions Code; Sections 25.6,
25.9, 34.5, 34.7, 34.9 and 34.10, Civil Code,
History
1. New section filed 10-31-78 as an emergency, designated effective 11-1-78
(Register 78, No. 44).
2. Certificate of Compliance filed 2-6-79 (Register 79, No. 15).
3. New subsection (c) filed 4-9-79; effecfive thirtieth day thereafter (Register 79,
No. 15).
4. Amendment filed 4-28-82; effective thirtieth day thereafter (Register 82, No.
18).
5. Editorial correcfion filed 7-7-83 (Register 83, No. 29).
6. Amendment of subsections (c) and (d) filed 3-9-90 as an emergency; operative
3-9-90 (Register 90, No. 12). A Certificate of Compliance must be transmitted
to OAL within 1 20 days or emergency language will be repealed on 7-9-90.
7. Amendment refiled 7-9-90 as an emergency; operative 7-9-90 (Register 90,
No. 35). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed by operafion of law on 1 1 -6-90.
8. Request to readopt amendment on an emergency basis pursuant to Government
Code section 11346.1 granted and filed 11-6-90 as an emergency; operative
1 1-6-90 (Register 91, No. 6). A Certificate of Compliance must be transmitted
to OAL within 120 days or emergency language will be repealed on 3-6-91 .
9. Certificate of Compliance as to 1 1-6-90 order transmitted to OAL 2-22-91;
disapproved by OAL on 3-25-91 (Register 91, No. 18).
10. Amendment of subsections (c) and (d) filed 3-25-91 as an emergency; opera-
tive 3-25-91 (Register 91, No. 18). A Certificate of Compliance must be trans-
mitted to OAL by 7-23-91 or emergency language will be repealed by opera-
tion of law on the following day.
1 1 . Certificate of Compliance as to 3-25-91 order transmitted to OAL 7-19-91
and filed 8-19-91 (Register 92, No. 1).
§ 50148. Application for Retroactive Medi-Cal.
(a) A person or family applying for retroactive Medi-Cal shall:
(1) Submit a completed application form to the county department, if
the application is for retroactive coverage only.
(2) Request retroactive coverage in one of the following ways if the
request for retroactive Medi-Cal is made in conjunction with, or after, an
application for public assistance or Medi-Cal:
(A) On the application form.
(B) On the Statement of Facts.
(C) By submitting a written request.
(b) An application for retroactive coverage pursuant to (a)(2) must be
submitted within one year of the month for which retroactive coverage
is requested.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Insfitutions
Code. Reference: Sections 11050, 14001, 14019 and 14019.6, Welfare and Institu-
tions Code.
History
1. Editorial correction adding NOTE filed 7-7-83 (Register 83, No. 29).
2. New subsecfion (b) filed 7-9-87; operafive 8-8-87 (Register 87, No. 30).
Page 323
Register 96, No. 34; 8-23-96
§ 50149
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
§50149. Application Form.
(a) An application for Public Social Services shall be used as the appli-
cation form for all Medi-Cal applications.
(b) The original of the completed form shall be placed in the case file.
(c) A copy of the completed form shall be given to the applicant at the
time of application.
(d) Only one person's signature shall be required on the application or
any other forms necessary to complete the eligibility determination.
(e) A new appUcation form shall not be required for:
(1) Requests for restoration of aid.
(2) Interprogram transfers.
(3) Interprogram status changes.
(4) Request to add a family member to the Medi-Cal case.
(5) Redeterminations.
(6) Infants meeting the criteria under the Continued Eligibility Pro-
gram as described in Section 50262.3.
NOTE: Authority cited: Sections 10725, 1 4016. 10 and 141 24.5, Welfare and Insti-
tutions Code. Reference: Sections 1 1050, 1 1053 and 14001, Welfare and Institu-
tions Code.
HtSTORY
1. Editorial correction filed 7-7-83 (Register 83, No. 29).
2. New subsection (e)(6) and amendment of Note filed 4-27-94 as an emergency;
operative 4-27-94 (Register 94, No. 17). A Certificate of Compliance must be
transmitted to OAL by 8-25-94 or emergency language will be repealed by op-
eration of law on the following day.
3. Certificate of Compliance as to 4-27-94 order transmitted to OAL 8-24-94 and
filed 9-29-94 (Register 94, No. 39).
§ 501 51 . Date of the Application.
(a) The date of application for a person or family applying for Medi-
Cal shall be the date the completed application form is received by the
county department.
(b) The date of application for a person or family applying for Medi-
Cal in a county other than the county of responsibility shall be the date
the completed application form is received by the county department in
which the application is being made.
§ 50153. Medi-Cal Application — Process for All Programs.
(a) An application for Medi-Cal under any program other than SSI/
SSP shall be an application for Medi-Cal under all such programs for
which the person or family may be eligible.
(b) When taking an application, the county department shall:
(1) Determine the program under which the person or family may be
eligible.
(2) Process the application under the appropriate program. Applica-
tions by persons who appear to be eligible for SSI/SSP shall be processed
in accordance with (3). Applications by persons who appear to be eligible
for AFDC hall be processed in accordance with (4).
(3) Refer persons who may be eligible for SSI/SSP, and who do not
refuse to apply for that program, to the Social Security Administration for
a determination of SSI/SSP eligibility.
(A) The referral shall be documented in the case file.
(B) Pending the SSI/SSP determination, the county department shall
determine eligibility under any other program for which the person may
be eligible.
(4) Applicants who appear to be eligible for an AFDC cash grant shall
be advised of their potential eligibility and the application shall be pro-
cessed under the AFDC cash grant program if the applicant so desires.
The fact that the applicant was advised of potential AFDC cash grant eli-
gibility shall be documented in the case file.
(c) A person or family may choose to have their application processed
under any program for which they are eligible even if such program is not
the most advantageous.
§ 50155. Withdrawal of Application — Request for
Discontinuance.
(a) An applicant or beneficiary may withdraw an application for or re-
quest discontinuance from Medi-Cal by any of the following methods:
(1) Completion of a Request for Withdrawal of Application or Discon-
tinuance of Eligibility form.
(A) The original shall be placed in the case file.
(B) A copy shall be given to the applicant.
(2) Submission of a signed request for withdrawal or discontinuance.
The request for withdrawal or discontinuance shall be placed in the case
ftle.
(3) Failing to respond to a Notice of Action which requests that the
beneficiary contact the county to indicate a desire to continue eligibility.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 1 1050 and 14001, Welfare and Institutions Code.
History
1. Editorial correction filed 7-7-83 (Register 83, No. 29).
§ 50157. Face-to-Face Interview.
(a) A face-to-face interview with the applicant, or the person complet-
ing the Statement of Facts, is required only at the time of application,
reapplication, restoration or as specified in (d). The interview shall be
completed within 30 days of the date of application, reapplication or res-
toration.
(b) A face-to-face interview shall not be required at time of applica-
tion, reapplication or restoration for persons who have a government rep-
resentative, such as a public guardian, acting on their behalf.
(c) A face-to-face interview at restoration shall not be required, for
beneficiaries who have been notified that eligibility will be discontinued,
if the request for restoration is received before the effective date of dis-
continuance.
(d) A face-to-face interview shall be required at redetermination of
eligibility for persons or families indicated in this paragraph. The inter-
view shall be completed within the month in which redetermination is re-
quired. A face-to-face interview shall be completed once a year at time
of redetermination for all MFBUs which contain at least one AFDC-MN
or MI member, except for MFBUs consisting of any of the following:
(1) Persons who receive Medi-Cal through the Aid for Adoption of
Children program.
(2) Persons who have a government representative, such as a public
guardian, acting on their behalf.
(3) MI children who are not living with a parent or relative and for
whom a public agency is assuming financial responsibility in whole or
in part.
(e) The face-to-face interview shall be conducted by a representative
of the county department unless, for good reason, a direct interview be-
tween the county department and the applicant or the person completing
the Statement of Facts is not possible. In such a situation, the interview
may be conducted by another public agency acting on behalf of the
county department.
(f) The representative of the agency conducting the interview shall
verbally advise the applicant, or the person completing the Statement of
Facts, in detail of the:
(1) Eligibihty requirements.
(2) Medi-Cal benefits available under the Medi-Cal program.
(3) Confidential nature of information received, including the fact that
the parents will not be contacted, without the applicant's consent if the
applicant is a child, requesting Medi-Cal for minor consent services in
accordance with Section 50147.1.
(4) Exchange of income and eligibility information through lEVS, in-
cluding the fact that tax information will be obtained and that lEVS infor-
mation will be used to verify income and eligibility.
(5) Purposes, provisions and availability of social services, the Family
Planning Program, Child Health Disability Prevention (CHDP) Pro-
gram, Special Supplemental Food Program for Women, Infants and Chil-
dren (WIC) and other public or private resources.
(A) If the applicant is a pregnant, breastfeeding or postpartum woman
as defined in Title 42, United States Code, Section 1786(b), or a parent/
guardian of a child under the age of five, the applicant shall be provided
with a WIC brochure to inform them of the availability of benefits pro-
vided under WIC.
Page 324
Register 96, No. 34; 8-23-96
Title 22
Health Care Services
§ 50157
•
•
(B) An oral explanation of the Special Supplemental Food Program for
WIC benefits shall be given to those individuals who are unable to read.
(C) Referrals shall be made to the WIC program for all such individu-
als as specified in (A).
(D) The representative of the agency conducting the interview shall
document by a notation on the Statement of Facts that the requirements
of the CHDP program, as specified in subsections (f)(5) and (k) and Sec-
tion 501 84(b), and of the Special Supplemental Food Program for Wom-
en, Infants and Children (WIC) program as specified in (f)(5) and Section
50184(c), have been met.
(6) Possibility of being included in a quality control sample.
(7) Availability of Medi-Cal prepaid health plans and PCCM plans in
the area.
(8) Right to request a fair hearing.
(9) Responsibility to report to the county department and to any pro-
vider of health care services any existing contractual or other legal en-
titlement to other health care coverage; and, to fully utilize other health
care coverage before using Medi-Cal benefits. The information to be re-
ported shall include the name of the other health care coverage, policy
and group numbers, and termination date, if available. Willful failure to
comply with these requirements is a misdemeanor.
(10) Responsibility to report to the county department the availability
of any option to obtain other health care coverage through, but not limited
to, the beneficiary's employer, labor union, trust fund, spouse or parent
and to provide information requested by the Department which is neces-
sary to determine if it would be cost effective for the Department to pay
the premium to obtain or continue other health care coverage.
(11) Responsibility to apply for, and/or retain any available other
health care coverage when there is no premium cost to the beneficiary.
Compliance with this requirement shall be a condition of coverage for
Medi-Cal covered benefits to the party responsible for the acquisition or
continuance of such health care coverage, and shall not interfere with
Medi-Cal benefits provided to the remaining family unit.
(12) Assignment of Rights Requirements as follows:
(A) Assignment to the state by an applicant, beneficiary, caretaker rel-
ative, or individual applying on behalf of an applicant, of all rights to
medical support and to payments for medical care from a third party is
a condition of eligibility.
(B) Receipts of Medi-Cal benefits shall constitute an assignment by
operation of law except as provided below. This means that receipt of
Medi-Cal benefits shall constitute automatic assignment of these rights
that the individual may assign on his/her behalf, or on behalf of any other
family member for whom he/she has the legal authority to assign such
rights, as required in Section 50185.
(C) The county shall advise the individual that he/she has the right to
refuse to assign these rights on behalf of himself/herself or the child on
whose behalf application is made.
(D) An applicant, beneficiary, parent, or caretaker relative who does
not wish to assign his/her rights or the rights of a person for whom he/she
can legally assign rights to medical support and payments shall be given
the opportunity to withdraw his/her Medi-Cal application, as specified
in Section 50155.
(E) Refusal of the individual to assign these rights shall result in his/her
denial or discontinuance of Medi-Cal eligibility.
(13) Responsibility of the applicant, beneficiary, parent, caretaker rel-
ative, or individual applying on behalf of the applicant, to cooperate in:
(A) Identifying and locating the absent parent.
(B) Estabhshing paternity for a child bom out of wedlock for whom
Medi-Cal is requested.
(C) Obtaining medical support and payments.
(D) Identifying and providing information concerning any third party
who is or may be liable for medical care and services.
Failure of the applicant, beneficiary, parent, caretaker relative, or indi-
vidual acting on behalf of an applicant to comply with the above shall re-
sult in denial or discontinuance of his/her eligibility unless good cause
exists for not cooperating, as specified in Section 50771.5. If the appli-
cant/beneficiary is a pregnant woman, cooperation with Sections (A),
(B), and (C) above is waived until the end of the 60-day postpartum peri-
od.
(14) Applicant's or beneficiary's responsibilities as specified in Sec-
tions 50185 and 50187 which include but are not limited to:
(A) Responsibility to report to the county department when Medi-Cal
may be billed for health care services received by the beneficiary as a re-
sult of an accident or injury caused by some other person's action or fail-
ure to act.
(B) Responsibility to report any changes in circumstances which may
affect eligibility or share of cost within 10 calendar days following the
date the change occurred.
(C) Responsibility to furnish Social Security account numbers for all
persons for whom Medi-Cal is requested.
(D) Responsibihty to apply for Medicare, if eligible, and furnish the
Health Insurance Claim Number.
(g) During the interview, the representative of the agency conducting
the interview shall complete and explain the contents of the following
forms if the forms were not completed during screening:
(1 ) Important Information for Persons Requesting Medi-Cal (MC 210
Coversheet(9/91))
(2) Statement of Facts (Medi-Cal (MC 210 (3/92))
(3) Child Support Questionnaire (CA 2.1 Q Support Questionnaire
(3/93)) and the Child/Spousal and Medical Support Notice and Agree-
ment (CA 2.1 Notice of Agreement (12/89));
(4) Child Support Enforcement Program Notice (CS 1 96 (1 2/92)); and
(h) The applicant shall sign and date the forms referenced in subsec-
tion (g).
(i) The original of the Important Information for Persons Requesting
Medi-Cal (MC 210 Coversheet (9/91)), and a copy of the Child Support
Questionnaire (CA 2.1 Q Support Questionnaire (3/93)), and the Child/
Spousal and Medical Support Notice and Agreement (CA 2.1 Notice of
Agreement (12/89)) shall be placed in the case file.
(j) A copy of each relevant form referenced in i shall be given to the
persons being interviewed and the originals of the Child Support Ques-
tionnaire (CA 2.1 Q (3/93)) and the Child/Spousal and Medical Support
Notice and Agreement (CA 2.1 Notice of Agreement (12/89)) shall be
forwarded, within two working days, to the district attorney.
(k) An informational pamphlet on the CHDP program shall be given
to the applicant, if there are persons under 21 years of age in the family,
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 11004, 14000, 14001, 14005, 14005.4, 14008.6,
14010, 14011, 14012, 14023, 14088.3, 14100.2 and 14124.91, Welfare and Insti-
tutions Code; and Section 1902(a), Social Security Act, Title 42, United States
Code, Section 1786(b); Title 42, United States Code, Sections
1396a(a)(ll),(51),(52) and (53); Title 42, Code of Federal Regulations, Section
431.635; 42 CFR, Subpart M, 431 .635; and 42 C.F.R. Sections 433. 135, 433.136,
433.137, 433.138, 433.145, 433.146, 433.147, 433.148 and 435.604.
History
1. Amendment of subsection (c) filed 12-15-77; effective thirtieth day thereafter
(Register77, No. 51).
2. Amendment filed 9-1-78; effective thirtieth day thereafter (Register 78, No.
35).
3. Amendment of subsection (d)(3) filed 8-8-80; effective thirtieth day thereafter
(Register 80, No. 32).
4. Amendment filed 1-8-81 ; effective thirtieth day thereafter (Register 8 1 , No. 2).
5. Editorial correction filed 7-7-83 (Register 83, No. 29).
6. Amendment of subsection (f) filed 7-16-87; operative 7-16-87 pursuant to
Government Code section 11346.2(d) (Register 87, No. 30).
7. Amendment of subsection (f) filed 6-28-89; operative 7-28-89 (Register 89,
No. 26).
8. Amendment of subsection (f)(7) filed 3-9-90 as an emergency; operative
3-9-90 (Register 90, No. 12). A Certificate of Compliance must be transmitted
to OAL within 120 days or emergency language will be repealed on 7-9-90.
9. Amendment refiled 7-9-90 as an emergency; operative 7-9-90 (Register 90,
No. 35). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed by operation of law on 11-6-90.
Page 325
Register 96, No. 34; 8-23-96
§ 50159
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
10. Request to readopt amendment on an emergency basis pursuant to Govern-
ment Code section 1 1346.1 granted and filed 11 -6-90 as an emergency; opera-
live 1 1-6-90 (Register 91, No. 6). A Certificate of Compliance must be trans-
mitted to OAL by 3-6-91 or emergency language will be repealed by operation
of law on the following day.
1 1 . Certificate of Compliance as to 1 1 -6-90 order transmitted to OAL 2-22-91 ;
disapproved by OAL on 3-25-91 (Register 9L No. 18).
12. Amendment of subsection (f) filed 3-25-91 as an emergency; operative
3-25-91 (Register91,No. 18). A Certificate ofCompliance must be transmitted
to OAL by 7-23-91 or emergency language will be repealed by operation of law
on the following day.
13. Certificate ofCompliance as to 3-25-91 order transmitted to OAL 7-19-91
and filed 8-19-91 (Register 92, No. 1).
14. Amendment of section and Note filed 4-16-93 as an emergency; operative
4-16-93 (Register 93, No. 16). A Certificate ofCompliance must be transmitted
to OAL 8-16-93 or emergency language will be repealed by operation of law
on the following day.
15. Certificate ofCompliance as to 4-1 6-93 order includins amendment of Note
transmitted to OAL 8-13-93 and filed 9-23-93 (Register 93, No. 39).
16. Amendment of subsection (f)(5), new subsections (f)(5)(A)-(D). repealer of
subsection (/) and amendment of Note filed 8-22-96; operative 9-21-96 (Reg-
ister 96, No. 34).
§ 501 59. Statement of Facts.
(a) Following completion of the application form, a Statement of Facts
shall be completed, signed and filed with the county department.
(b) The Statement of Facts shall be used by the county department in
the determination of the applicant's:
(1) Eligibility.
(2) Share of cost.
(3) Other health care coverage.
§ 501 61 . Statement of Facts Form.
(a) A Statement of Facts is not required in determining Medi-Cal
eligibility for a child receiving aid under the Aid for Adoption of Chil-
dren program.
(b) A public agency, applying on behalf of a child who may be ehgible
as an MI child who is not living with a parent or relative and for whom
a public agency is assuming financial responsibility in whole or in part,
shall complete the Application and Statement of Facts for Child in Foster
Care Supported by Public Funds, MC 250.
(c) An applicant applying for Medi-Cal under any other program shall
complete the Statement of Facts, form MC 210.
(d) A person applying for Medi-Cal and requesting retroactive cover-
age shall complete the appropriate Statement of Facts for the current
month and the Supplement to Statement of Facts for Retroactive Covera-
ge/Restoration, MC 213, for the retroactive months. If only retroactive
coverage is requested, a Statement of Facts, MC 210, shall be completed
for one retroactive month for which Medi-Cal is requested and the MC
213 shall be completed for each additional retroactive month.
(e) An applicant or beneficiary who has a form CA 2 which has been
completed within the last 1 2 months and which is on file with the county
department need not complete the MC 210, unless the county department
determines that the applicant's or beneficiary's circumstances have
changed to such a degree as to require a new Statement of Facts.
(0 Any person requesting a restoration of Medi-Cal-only eligibility
shall complete the Supplement to Statement of Facts for Retroactive
Coverage/Restoration, form MC 213, unless the county department de-
termines that the applicant's circumstances have changed to such a de-
gree as to require a new MC 210, or unless a new MC 210 is required as
part of redetermination of eligibility under Section 50189.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14005.4, Welfare and Institutions Code.
History
1. Amendment of subsection (c) filed 12-15-77; effective thirtieth day thereafter
(Register 77, No. 51).
2. Amendment filed 8-7-78; effective thirtieth day thereafter (Register 78, No.
32).
3. Amendment of subsection (b) filed 8-8-80; effective thirtieth day thereafter
(Register 80, No. 32).
§ 50163. Persons Who May Complete and Sign the
Statement of Facts.
(a) The apphcant or spouse of the applicant shall complete and sign the
Statement of Facts, unless:
(1 ) The applicant is a child. Generally, the person or agency having le-
gal responsibility for the child shall complete and sign the Statement of
Facts. The child shall complete and sign the Statement of Facts if the
child is competent and either of the following applies:
(A) The child is not Hving with the child's parents or caretaker rela-
tives and the county has determined that no person or agency accepts le-
gal responsibiUty for the child.
(B) The child is applying on his or her own behalf in accordance with
Section 50147.1 (a).
(2) The apphcant has a conservator, guardian or executor. In this case,
the conservator, guardian or executor shall complete and sign the State-
ment of Facts.
(3) The applicant is incompetent, in a comatose condition or suffering
from amnesia, and there is no spouse, conservator, guardian or executor.
In this case:
(A) The county department shall evaluate the applicant's circum-
stances and determine whether or not there is a need for protective ser-
vices.
(B) The Statement of Facts may be completed and signed on the appli-
cant' sbehalfby a relative, a person who has knowledge of the applicant's
circumstances, or a representative of a public agency or the county de-
partment.
(C) The person completing the Statement of Facts on behalf of the
applicant shall provide all available information required on the State-
ment of Facts regarding the applicant's circumstances.
(D) If a county department representative completes and signs the
Statement of Facts, another representative of that county department
shall:
1. Confirm, by personal contact, the applicant' s inability to act on his
own behalf.
2. Countersign and approve any recommendations for eligibility.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 11054, 14000, 14001, 14005.1, 14005.4, 14005.7,
14008, 14008.5, 14010, 14011, 14017, 14018 and 14051.5, Welfare and Institu-
tions Code; Sections 25.6, 34.5, 34.7, 34.9 and 34.10, Civil Code.
History
1. Amendment of subsection (a)(1) filed 10-31-78 as an emergency; designated
effective 1 1-1-78 (Register 78, No. 44).
2. Certificate ofCompliance filed 2-6-79 (Register 79, No. 6).
3. Amendment filed 5-30-79 as an emergency; designated effective 6-1-79 (Reg-
ister 79, No. 22).
4. Certificate ofCompliance filed 9-19-79 (Register 79, No. 38).
5. Amendment of subsection (a)(1)(A) filed 2-1 1-82; effective thirtieth day there-
after (Register 82, No. 7).
6. Editorial correction of NOTE filed 7-7-83 (Register 83, No. 29).
§ 501 65. Filing the Statement of Facts.
(a) At the time the Statement of Facts is given or mailed to an applicant,
the county department shall:
( 1 ) Set a reasonable deadline for returning the Statement of Facts to the
county department.
(2) Inform the applicant of the deadline.
(b) If the Statement of Facts is not returned personally or by mail by
the deadline specified in (a), the county department shall:
(1) Attempt to contact the applicant or beneficiary to determine the
reason for the delay.
(2) Extend the deadline for returning the Statement of Facts if a valid
reason for the delay, such as incapacity, is found.
(3) Deny the application or discontinue eligibility if a valid reason for
the delay cannot be established.
(c) A copy of the completed Statement of Facts shall be provided to
the individual who signed it, at the request of that individual.
Page 326
Register 96, No. 34; 8-23-96
•
Title 22 Health Care Services § 50166
NOTE: Authority cited: Sections 10725 and 141 24.5, Welfare and Institutions completing the Statement of Facts in accordance with Section
Code. Reference: Sections 10001, 10060, 1 1004, 1 1050, 11054, 14001, 14011 and 50163(a)(3) shall:
14012. Welfare and Institutions Code. ' /ind r j-i- . u^ u ■ -i ui • r .• j-
History (l)Periorm a dihgent search to obtam available information regarding
1. Amendment of subsection (a) filed 12-15-77; effective thirtieth day thereafter ^he applicant's circumstances applicable to Medi-Cal eligibility deter-
(Register 77, No. 51). mination.
2. Editorial correction adding NOTE filed 7-7-83 (Register 83, No. 29). (2) Complete the Statement of Facts based upon the findings of the dil-
§ 50166. Obtaining Information for the Completion of the igent search.
Statement of Facts.
(a) The county department or the representative of a public agency
[The next page is 327.]
Page 326.1 Register 96, No. 34; 8-23-96
Title 22
Health Care Services
§ 50167
(3) Establish disability in accordance with Section 50167(a)(1).
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institution.s
Code. Reference: Sections 1 1054, 14000, 14001 , and 1401 1, Welfare and Institu-
tions Code.
History
1 . New section filed 5-30-79 as an emergency; designated effective 6-1-79 (Reg-
ister 79, No. 22).
2. Certificate of Compliance filed 9-19-79 (Register 79, No. 38).
§ 501 67. Verification — Prior to Approval.
(a) With regard to information on the Statement of Facts, the county
department shall obtain verification of the following items in the manner
specified below, prior to approval of eligibility:
(1) Blindness, as determined in accordance with Section 50219, and
federal disability, as determined in accordance with Section 50223 (a)(1)
or (b), shall be verified by any of the following methods:
(A) By determining that the person was eligible as an MN person on
the basis of blindness or disability in December 1973, and that there has
been continuing eligibility since that time.
(B) By obtaining verification that a prior determination of blindness
or disability is still valid. Verification shall be documented by viewing
any of the following or si milar items and noting in the case record the date
of the award letter or notification and the disability onset and reexamina-
tion dates:
1. A Social Security Administration Title II award letter indicating re-
ceipt of disability benefits provided the reexamination date has not
passed or a reexamination date is not indicated and the applicant is still
receiving those benefits.
2. A Social Security Administration notification that Title II disability
benefits have been increased or decreased provided the applicant is still
receiving those benefits.
3. A Railroad Retirement Board notification of a total and permanent
disability award provided the applicant is still receiving those benefits.
4. A signed statement from the Social Security Administration that
states that the person is eligible for Title II benefits on the basis of a dis-
ability.
5. Documentation of a prior determination of disability under the MN
program, if the determination was performed within the last 12 months
unless:
a. The reexamination date has passed.
b. The applicant indicates his/her physical or mental condition has im-
proved.
6. Data on the SDX or a signed statement from the Social Security Ad-
ministration indicating that a person was discontinued from SSI/SSP for
reasons other than cessation of disability provided the procedures speci-
fied in (D) are followed within twelve months of the SSI/SSP discontinu-
ance date.
(C) By obtaining a letter from a physician verifying any of the physical
or mental impairments meeting the federal definition of presumptive dis-
ability or blindness contained in Title 20, Code of Federal Regulations,
Section 416.934, provided the procedures specified in (D) are followed
after eligibility is determined.
(D) By following procedures established by the California Depart-
ment of Social Services, Disability Evaluation Division. All necessary
information shall be submitted to that division not later than 10 days after
the receipt of the Statement of Facts by the county, except in the event
of a delay due to circumstances beyond the control of the county.
(2) Incapacity, as defined in Section 5021 1 , shall be verified by view-
ing one of the following:
(A) A current Medical Report form or written statement signed by a
physician, licensed or certified psychologist or authorized member of
their staff which documents that incapacity exists and gives the expected
duration of the condition.
(B) A current Certificate of Disability form.
(C) Documentation of current receipt of Title II or Railroad Retire-
ment disability benefits.
(D) Documentation of current receipt of SSI/SSP benefits based on
disability or blindness.
(E) Documentation of current receipt of State Disability Insurance
(SDI) or Worker's Compensation.
(F) If a current Medical Report form or a written statement cannot be
obtained without delay, and no other verification of incapacity exists, a
verbal statement from one of the persons specified in (A) shall be ac-
cepted as verification for up to 60 days pending receipt of written verifi-
cation.
(3) Alien status shall be verified in accordance with the alienage verifi-
cation and documentation procedures described in Article 7.
(4) The fact that the parents and a public or private agency will not ac-
cept legal responsibility for a child shall be verified by documented ver-
bal or written communication with the parents and agencies, if the child
is applying alone on the basis that neither the parents nor an agency will
accept legal responsibility.
(5) SGA disability, as determined in accordance with Section 50223
(a) (2), shall be verified by following procedures established by the De-
partment of Social Services, Disability Evaluation Division. All neces-
sary information shall be submitted to the Department of Social Services
by the county not later than 10 days after the receipt of the Statement of
Facts by the county, except in the event of a delay due to circumstances
beyond the control of the county.
(6) Identity of all persons other than those listed in (D). Identity shall
be verified by viewing one of the following:
(A) California driver's license.
(B) Identification card issued by the Department of Motor Vehicles.
(C) Any other document which appears to be valid and establishes
identity.
(D) Persons who are:
1. In an institution and contact is made with the facility to verify pres-
ence in the institution.
2. Receiving Medi-Cal through the Aid for Adoption of Children pro-
gram.
3. Children in a family, if identity of one parent has been verified
4. Children requesting Medi-Cal for minor consent services in accor-
dance with Section 50147.1.
5. MI children who are not living with a parent or relative and for
whom a public agency is assuming financial responsibility in whole or
in part.
6. Not acting on their own behalf and a government representative,
such as a public guardian, is acting for them.
7. The spouse of a person whose identity has been verified.
(7) The following income and resources:
(A) Unearned income, which shall be verified by viewing any of the
following:
1. Data from the lEVS which confirms information on the Statement
of Facts.
2. Checks or copies of checks. County departments shall not require
copies of checks issued by the United States Government.
3. Award letters.
4. Signed statements from persons or organizations providing the in-
come.
5. Check stubs.
6. Statements from checking, savings or trust fund accounts which in-
dicate that the income is directly deposited for the applicant or beneficia-
ry by the persons or organizations providing the income.
7. The statement of the person completing the Statement of Facts, for
income received from the United States Government. This statement
shall constitute verification pending receipt by the county department of
verification from appropriate government agency, when the verification
in 1 through 6 cannot be provided.
(B) Income in kind, which shall be verified by a written statement from
the provider of the items of need. Verification shall be limited to those
items which the appHcant is claiming have a lower value than the values
estabhshed in accordance with Section 5051 1 (b).
Page 327
Register 96, No. 47; 11-22-96
§ 50167
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
(C) Earned income, which shall be verified by viewing paycheck
stubs. If paycheck stubs are not available, a signed statement from the
employer verifying the amount and frequency of the payments shall be
obtained. If an individual is self-employed, records kept by such individ-
ual for tax purposes shall be viewed.
1. Therapeutic Wages as defined in Section 50095.5 shall be verified
by obtaining all of the following:
a. A statement from the individual's physician which provides that he/
she has no financial interest in the LTC facility in which the individual
resides and that the work has been prescribed as therapy for the individu-
al.
b. A statement from the facility in which the individual resides verify-
ing the individual's employment by that facility and that such employ-
ment does not displace any existing employees.
c. A statement(s) from the facility(ies) verifying that the individual has
been an LTC resident for a continuous period commencing at least five
years prior to September, 1984.
d. The provisions of this regulation also apply to eligibility determina-
tion or redeterminations made retroactively to October 1, 1984.
(D) Fluctuating income, which shall be verified by viewing check
stubs or a copy of the checks that show the amount of income. If these
are not available a signed statement from the person or organization mak-
ing the payments verifying the amount and frequency of the payments
shall be obtained.
(E) Child care costs, which shall be verified by viewing receipts and/or
canceled checks.
(F) Cost of care for an incapacitated person wliile someone else is
employed, which shall be verified by viewing receipts and/or canceled
checks.
(G) Deductible expenses for maintenance or improvement of income-
producing property, as defined in Section 50508, which shall be verified
by viewing actual receipts for such services or a signed statement from
the person providing the service or goods verifying the nature and cost
of the service or goods.
(H) The market value of real property, other than the principal resi-
dence, which shall be verified by viewing any of the following:
1. A current incorporated tax statement from the county Tax Asses-
sor's Office.
2. Records maintained by the County Tax Assessor.
3. A written statement from a qualified real estate appraiser which
gives the appraisal value of the property, when the applicant chooses to
meet the conditions of Section 50412(a)(3).
(I) Checking or savings account balances, which shall be verified by
viewing either of the following:
1. A current account statement from the institutions holding the funds.
2. Signed correspondence from the institution holding the funds.
(J) The value of stocks, bonds and mutual funds, which shall be veri-
fied by both:
1. Viewing the certificate or a signed statement from the issuing insti-
tution stating a description of the investment, including the number of
shares owned.
2. Taking one of the following actions:
a. Telephone contact with a recognized stock exchange broker to es-
tablish at the current selling price of the property.
b. Establishment of the current selling price of the property through
listings in a current newspaper.
(K) U.S. Savings Bonds values, which shall be verified by viewing the
bond and by contacting any bank or institution where such bonds may be
liquidated.
(L) The value of deeds of trusts, mortgages and other promissory
notes, which shall be verified by both:
1 . Viewing documents which state a description of the item.
2. Taking one of the following actions:
a. Viewing documents from the lender which establish the principal
amount remaining on the note.
b. Viewing an appraisal obtained from a party qualified to appraise
mortgages and notes as described in Section 50441 (c)(2).
c. Making a telephone contact with a recognized broker who buys,
sells or appraises such items.
(M) The value of nonexempt motor vehicles, boats, campers or trail-
ers, which shall be verified by viewing the appropriate document as fol-
lows:
1. Vehicle registration.
2. Appraisal statements when obtained pursuant to Sections 50461 and
50463.
(N) The cash surrender value of nonexempt life insurance policies,
which shall be verified by viewing either of the following:
1. The value tables included in the policy.
2. Signed correspondence from the carrier indicating the current value.
(O) The value of nonexempt jewelry, which shall be verified by re-
viewing the appraisal statements.
(P) The value of burial trusts or prepaid burial contracts, which shall
be verified by viewing the actual trust or contract or by viewing signed
correspondence from the trustor or contractor which details its value.
(Q) The value of nonexempt property held in trust, which shall be veri-
fied by viewing either of the following:
1. A document indicating the trust's current value, executed by the
trustor or executor.
2. An appraisal of the property obtained by the applicant from an agent
qualified to appraise such property.
(R) Encumbrances of record on any item of property subject to verifi-
cation, which shall be verified by either of the following:
1 . A payment book issued by the insfitution or person holding the en-
cumbrance which indicates the current amount of the encumbrance.
2. Written correspondence stating the amount of the encumbrance ob-
tained by the applicant from the institution or person holding the encum-
brance.
(S) The value of oil leases or mineral rights which shall be verified by
one of the following:
1 . Written or telephone contact with a member of a recognized profes-
sional appraisal society which establishes the current market value of the
lease or right.
2. Viewing records maintained by the county tax assessor where the
lease or right is located.
3. Written or telephone contact with the company/organization devel-
oping the natural resource which establishes the current market value.
(T) Health care benefits available through employment, retirement or
military service which shall be verified by viewing those insurance poli-
cies which specifically name the applicant, health benefit identificafion
cards, or letters from health care benefit providers. Health care benefits
available through work related injuries or settlements from prior injuries
shall be verified by viewing letters from the Workmen's Compensation
Board, employers, or insurance companies.
(U) Application for uncondidonally available income as determined
in accordance with Section 50186, which shall be verified by viewing:
1. A Veterans Benefit Referral form, referral for veterans benefits.
2. Application printouts for disability insurance benefits.
3. Application printouts for unemployment insurance benefits.
4. Application receipts for OASDI benefits.
5. Application receipts for any other uncondifionally available income
source.
(V) Employee retirement contributions and other employee benefit
contributions which shall be verified by viewing a statement from the
employer.
(8) Except for women applying for minor consent services under Sec-
tion 50147. 1 , a woman whose eligibility or share of cost is based on preg-
nancy shall provide a letter of verification from either a physician or a
person certified as a nurse pracfitioner, midwife or physician's assistant.
(9) Property as defined in SecUon 50425 (a)(7) is listed for sale with
a licensed real estate broker at its fair market value and a bona fide at-
Page 328
Register 96, No. 47; 11-22-96
Title 22
Health Care Services
§ 50168
tempt is being made to sell such property. This shall be verified by view-
ing a listing contract and appraisal from a qualified real estate appraiser.
(10) California residency shall be verified in accordance with Sections
50320.1 and 50320.2.
(b) The provisions of this section apply to all items listed in (a) at:
(1) Initial application and reapplication.
(2) The time a change is reported or at redetermination for items not
previously verified.
(3) Redetermination for items which the county determines could have
appreciated in value since the last verification.
(c) The applicant or the county shall make a diligent search to obtain
documentation necessary to verify items (a)(7)(A) through (a)(7)(V) and
(a)(9) above. Such a search shall include at a minimum, one contact with
the appropriate person/organization from which this documentation
could be obtained. When the county determines that such documentation
cannot be obtained either by the applicant or by county within the
promptness requirements listed in Section 50177. the county shall:
(1) List and retain in the case record all actions taken to obtain docu-
mentation required for verification.
(2) Obtain from the applicant, and retain in the case record, an affidavit
dated and signed by the applicant under penalty of perjury which lists a
description and value of any item for which documentation for verifica-
tion purposes was determined not available.
(3) Obtain a signed and dated affidavit from the applicant under penal-
ty of perjury which hsts the amounts of any earned or unearned income
received and retain this document in the case record.
NOTE: Authoritv cited: Sections 10725. 10740, 14006.1 and 14124.5, Welfare and
Institutions Code. Reference: Sections 12305.5, 14001, 14005.1, 14005.3,
14005.4, 14005.7, 14005.13, 14006, 14007.5, 14008, 14010, 14011, 14017,
14018, 14051.5, 14148 and 14148.5, Welfare and Institutions Code; Sections
25.6. 34.5, 34.7, 34.9 and 34.10, Civil Code; Section 66 of Chapter 722, Statutes
of 1992; Title 20, Code of Federal Regulations, Section 416.934; and 42 Code of
Federal Regulations, 435.948.
History
1. Amendment of subsection (a)(8) filed 6-27-89 as an emergency; operative
6-27-89 (Register 89, No. 26). A Certificate of Compliance must be transmitted
to OAL within 120 days or emergency language will be repeated on 10-25-89.
For prior history, see Register 87, No. 30.
2. Certificate of Compliance transmitted to OAL 10-25-89 and filed 11-22-89
(Register 89, No. 48).
3. Amendment of subsection (a)(1) filed 4-17-89; operative 5-17-89 (Register
89, No. 48).
4. New subsection (a)(10) and amendment of Note filed 5-1 7-93 as an emergen-
cy with Secretary of State by the Department of Health Services; operative
5-1 7-93. Submitted to OAL for printing only pursuant to 1992 Senate Bill 485
(Register93, No. 21).
5. Amendment of subsections (a)( 1 )(B) 1 .-2., (a)( 1 )(B)4.-5. and (a)( 1 )(C), repeal-
er of subsections (a)(1)(C) 1.-13., amendment of subsections (a)(1)(D) and
(a)(2), and amendment of Note filed 1 1-20-96; operative 12-20-96 (Register
96, No. 47).
§ 501 67.2. Verification of Income — lEVS Requirements.
(a) In administering the Medi-Cal program, the county department
shall adhere to the requirements in Division 20.006, Manual of Policy
and Procedures, Department of Social Services, governing:
(1) Submission of information to lEVS on applicants, beneficiaries
and any other family member whose income and resources are consid-
ered in establishing eligibility and share of cost, for persons in long-term
care status except as provided in (c).
(2) Use of matched lEVS information received from the Departments
of Health Services and Social Services.
(3) Time requirements for completing case action based on lEVS in-
formation.
(4) Maintenance of records.
(5) Submission of reports.
(b) The county department shall review and compare the lEVS infor-
mation against information contained in the case file and shall verify that
lEVS information pertains to the applicant, beneficiary or other family
member and is applicable to case circumstances in accordance with pro-
cedures established by the Department prior to taking case action based
upon lEVS information alone.
(c) The county departtnent shall submit information on persons in
Long-Term Care status only at application and at the annual redetermi-
nation.
(d) In addition to the requirements of (a) the county department shall
submit to the Department for submittal to the State Wage Information
Collection Agency, the name and Social Security Number of the absent
parent of any child in the MFBU to the extent such information is avail-
able in order to identify employers of the absent parent and any third
party liability.
NOTE: Authority cited: Sections 10725. 10740 and 14124.5. Welfare and Institu-
tions Code. Reference: 42 Code of Federal Regulations 433.138(c) and (d), and
435.940-435.965.
History
1. New section filed 7-16-87; operative 7-16-87 pursuant to Government Code
Section 11346.2(d) (Register 87, No. 30).
§ 50167.5. Verification of Unearned Income Information
from Internal Revenue Service (IRS) or
Franchise Tax Board (FIB)— lEVS
Requirements.
(a) The county departtnent shall not deny or terminate benefits to an
applicant or beneficiary or increase the share of cost based on unearned
income information from IRS or FTB until it has:
(1) Verified the amount of the income and the value of the property in-
volved.
(2) Established whether the income or property was available to the in-
dividual.
(3) Determined the period or periods when the individual actually had
the income or property.
(b) The county department shall verify the IRS or FTB information by
either:
(1) Contacting the individual by a letter, written in a neutral, nonaccu-
satory manner, which advises of the:
(A) Information received from lEVS.
(B) Potential impact on eligibility or share of cost.
(C) Requirement to respond within 10 days.
(D) Consequences of failure to respond to the inquiry, as specified in
Section 50175.
(2) Referring the case to the Department for investigation in accor-
dance with procedures established by the Department.
NOTE: Authority cited: Sections 10725, 10740 and 14124.5, Welfare and Institu-
tions Code. Reference: Secfions 1 1004, 1 1025, 14001, 1401 1 and 14014, Welfare
and Institutions Code; and 42 Code of Federal Regulations 435.955.
History
1. New section filed 7-16-87; operative 7-16-87 pursuant to Government Code
Section 1 1346.2(d) (Register 87, No. 30).
§ 501 68. Verification— Within 60 Days.
(a) With regard to information on the Statement of Facts, the county
department shall obtain verification of the following items in the manner
specified below, within 60 days of the date of initial application, but not
necessarily prior to approval of eligibility:
(1) Social Security Numbers (SSNs) shall be submitted through the
lEVS to the Social Security Administration for verification in accor-
dance with procedures established by the Department.
(A) SSN(s) shall be confirmed by viewing Social Security cards, So-
cial Security Administration form series OA-702. Any one of the follow-
ing shall be acceptable if the Social Security card is not available:
1. An award letter, Medicare card or a check from the Social Security
Administration showing the applicant's name and SSN with letters A,
HA, J, T or M following the SSN.
2. Other documentation from the Social Security Administration upon
approval by the Department.
(B) Application for an SSN or evidence of an SSN shall be confirmed
by viewing Social Security Administration district office notification
that application for an SSN or evidence of an SSN has been made.
Page 329
Register 96, No. 47; 11-22-96
§ 50169
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
(b) Medicare eligibility shall be verified by viewing a Health Insur-
ance Card, form SSA-1966, an award letter showing the individual's
Health Insurance Claim number (HIC), an Explanation of Medicare
Benefits (EOMB) issued by the Medicare fiscal intermediary, or a bill for
Premium Part A or Part B, form SSA 1545 or 1545A.
(c) If a person or family receives a Medi-Cal card prior to verification
of an HIC number, SSN, application for an SSN or evidence of an SSN,
and that verification is not completed within the time limit for reasons
within the beneficiary's control:
( 1 ) Eligibility no longer exists and the person shall be discontinued. In
family situations only the person or persons whose number is not verified
shall be discontinued.
(2) Eligibility shall not be reapproved until the required evidence is
submitted.
NOTE: Authority cited: Sections 10725, 10740 and 14124.5, Welfare and Institu-
tions Code; and Section 57, Chapter 328. Statutes of 1982. Reference: Sections
11004, 14001 and 1401 1, Welfare and Institutions Code; and 42 Code of Federal
Regulations 435.910(g).
History
1. Amendment of subsections (a) and (b) filed 12-15-77; effective thirtieth day
thereafter (Register 77, No. 51).
2. Amendment of subsections (a) and (c) and new subsection (d) filed 4-9-80; ef-
fective thirtieth day thereafter (Register 80, No. 15).
3. Amendment filed 1-8-81 ; effective thirtieth day thereafter (Register 81, No. 2).
4. Amendment filed8-18-82 as an emergency; effective upon filing (Register 82,
No. 34). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 12-16-82.
5. Certificate of Compliance transmitted to OAL 12-14-82 and filed 1-21-83
(Register 83, No. 4).
6. Editorial correction of subsection (a)(1)(C) filed 7-7-83 (Register 83, No. 29).
7. Amendment filed 7-16-87; operative 7-16-87 pursuant to Government Code
Section 1 1346.2(d) (Register 87, No. 30).
§ 50169. Additional Verification Requirements.
(a) The county department shall not require verification of informa-
tion, other than the verification specified in these regulations, unless the
county department considers the verification necessary to ensure a cor-
rect eligibility determination in the specific case.
(b) The need for in-home supportive services as determined under the
IHSS program pursuant to the standards and procedures established for
that program, DSS Manual of Policies and Procedures, division 30, sec-
tions 30-700 through 30-775, shall be verified prior to the application
of the deduction specified in section 50551.6. Such determination and
verification shall be limited to the type and amount of services needed.
The payment for IHSS services shall be verified by viewing cancelled
checks, or receipts signed by the provider of service.
(c) The county department shall document in the case file the type of
verification obtained when verification is required under (a) or (b) or un-
der sections 50167 and 50168.
(d) The following items shall be verified at each redetermination, res-
toration or reapplication.
(1) Incapacity.
(2) Legal responsibility for a child applying alone.
(3) Refusal of the parent to apply for an 18 to 21 year old child.
(4) Income, except income received from the United States govern-
ment which has previously been verified in accordance with the provi-
sions of sections 501 67(a)(7)(A) 1. through 5. or for which verification
has been obtained from the appropriate government agency.
(5) Status and value of nonexempt property.
(6) The continuing need for IHSS services.
(7) Immigration status; provided, however, that the county department
shall not require or request an applicant for or a beneficiary of restricted
Medi-cal benefits to disclose their citizenship or immigration status,
birthplace, country of citizenship, alien registration number and/or alien
admission number, date of first entry into the United States, or name upon
first entry into the United States.
(e) County departments shall verify the immigration status of all alien
applicants for full Medi-Cal benefits and of persons applying for re-
stricted Medi-Cal benefits who indicate they are amnesty aliens.
(f) The following items shall be verified whenever there is a change:
(1) Blindness.
(2) Disability.
(3) Immigration status; provided, however, that the county department
shall not require or request an applicant for or a beneficiary of restricted
Medi-cal benefits to disclose their citizenship or immigration status,
birthplace, country of citizenship, alien registration number and/or alien
admission number, date of first entry into the United States, or name upon
first entry into the United States.
(4) SSN; provided, however, that the county department shall not re-
quire or request an applicant for or a beneficiary of restricted Medi-cal
benefits to disclose whether they have a Social Security Number or what
that number is.
(5) HIC number.
(6) A change in residency shall be verified whenever one of the follow-
ing conditions exists:
(A) The applicant or beneficiary is absent from the state for less than
60 days and claims to be a resident of California, and the county has evi-
dence to the contrary pursuant to SecUon 50321(a).
(B) The apphcant or beneficiary is absent from the state for more than
60 days and claims to meet the conditions of Section 50323 for maintain-
ing California residency.
(g) The following procedures shall apply, for persons who were deter-
mined eligible prior to the effective date of this subsection and who have
not submitted an SSN, at the time of the next redetermination, restoration
or reapplication:
(1) Section 50168(a)(1) shall apply when a face-to-face interview is
required.
(2) Persons for whom a face-to-face interview is not required shall
submit an SSN, or evidence of application for an SSN, within 60 days.
(h) Certification for Medi-Cal shall not be delayed or discontinued
pending receipt of verification from a person who is currently eligible un-
less the beneficiary refuses to cooperate.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Institutions
Code; Section 2, Chapter 364, Statutes of 1 984; and Section 9, Chapter 1441 , Stat-
utes of 1988. Reference: Secfions 14005.14, 14007.5 and 14011, Welfare and In-
stitutions Code; and the Crespin v. Kizer court order (Alameda County Superior
Court, December 16, 1992).
History
1. Amendment of subsections (d) and (e), and reletteringof subsecdons (e), (f) and
(g) filed 1 1-14-89 as an emergency pursuant to secfion 9 of chapter 1441 of the
Statutes of 1988; operative 1 1-14-89 (Register 89, No. 48). A Certificate
Page 330
Register 96, No. 47; 11-22-96
Title 22
Health Care Services
§ 50175
of Compliance must be transmitted to OAL within 1 20 days or emergency lan-
guage will be repealed on 3-14-90. For prior histoi^, see Register 85, No. 43.
2. Amendment of subsections (d) and (e), and relettering of subsections (e), (f) and
(g) refiled 3-8-90 as an emergency pursuant to section 9 of chapter 1441 of the
Statutes of 1988; operative 3-13-90 (Register 90. No. 12). A Certificate of
Compliance must be transmitted to OAL within 120 days or emergency lan-
guage will be repealed on 7-1 1-90.
3. Certificate of Compliance as to 3-8-90 order transmitted to OAL 7-05-90 and
disapproved 8-6-90 (Register 90, No. 42).
4. Amendment filed 8-23-90 as an emergency pursuant to section 9 of chapter 441
of the Statutes of 1988; operafive 8-23-90 (Register 90. No. 42). A Certificate
of Compliance must be transmitted to OAL by 12-21-90 or emergency lan-
guage will be repealed by operation of law on the following day.
5. Certificate of Compliance as to 8-23-90 order transmitted to OAL 1 1-20-90
and filed 12-17-90 (Register 91, No. 5).
6. New subsections (f)(6)-(f)(6)(B) and amendment of subsections (d)(7), (f)(3),
(f)(4) and Note filed 5-17-93 as an emergency with Secretary of State by the
Department of Health Services; operative 5-17-93. Submitted to OAL for
printing only pursuant to 1992 Senate Bill 485 (Register 93, No. 21).
§ 501 71 . Clarification of Statement of Facts.
(a) All information provided on the Statement of Facts other than that
verified in accordance with Sections 50167, 50168 and 50169 shall be
accepted as a basis for determination of eligibility and share of cost, un-
less the Statement of Facts is unclear or inconsistent.
(b) If additional clarification is needed, the county department shall in-
form the person who signed the Statement of Facts of the information
needed and the reason for the request. Such persons shall be responsible
for securing the additional information.
(c) If the person who signed the Statement of Facts has difficulty in se-
curing the necessary information, the county department shall, with the
person's written consent, obtain the information. The Applicant Authori-
zation for Release of Information form shall identify persons to be con-
tacted and the specific information to be requested.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 11004, 11050, 14001 and 14011, Welfare and Institu-
tions Code.
History
1. Amendment of subsection (b) and new subsection (c) filed 12-15-77; effective
thirtieth day thereafter (Register 77, No. 51).
2. Editorial con-ection of subsection (c) filed 7-7-83 (Register 83, No. 29).
§50172. Verification by Signature.
(a) The signature on the Statement of Facts shall be accepted as verifi-
cation of the facts if both of the following conditions are met, except as
specified in (c):
(1) The information required for establishing eligibility under these
regulations is not available.
(2) The county department determines that the information provided
on the Statement of Facts is sufficient to determine eligibility. If the infor-
mation on the Statement of Facts is insufficient, the county department
shall accept a signed statement, from the person completing the State-
ment of Facts, providing the necessary supplemental information.
(b) The county department shall state on the Statement of Facts that
this is the only method of verification available, if this method of verifica-
tion is used.
(c) The signature on the Statement of Facts shall not be accepted as
verification of a person's SSN, application for an SSN or for evidence of
an SSN.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14011, Welfare and Institutions Code.
History
1 . New section filed 12-1 5-77; effective thirtieth day thereafter (Register 77, No.
51).
2. Amendment of subsection (a) and new subsection (c) filed 4-9-80; effective
thirtieth day thereafter (Register 80, No. 15).
§ 50173. Eligibility Determination.
(a) The county department shall determine the person' s or family' s eli-
gibility and share of cost after the applicant for Medi-Cal has applied,
completed the Statement of Facts, and provided all essential information.
Tlie eligibility and share of cost deterinination shall be completed in the
following manner:
(1 ) Those persons whose eligibility is being determined as Other PA
recipients shall have their eligibility determined in accordance with the
regulations and procedures governing the program to which they are
linked and any other requirements applicable to their aid category, as spe-
cified in sections 50237 through 50247.
(2) Those persons whose eligibility is being determined as MN or MI
shall have their ehgibility and share of cost determined in accordance
with articles 4 through 13 (commencing with section 50141).
(b) A determination based on the results of a county search for infor-
mation under section 50166 shall be completed in the same manner as
any other determination.
(1) Only the income and resources discovered through the search shall
be considered available.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code: and Section 9, Chapter 1441, Statutes of 1988. Reference: Sections 1 1054,
14000, 14001, 14007.5 and 1401 1, Welfare and Institufions Code.
History
1. New subsection (b) filed 5-30-79 as an emergency; designated effecfive
6-1-79 (Register 79, No. 22).
2. Certificate of Compliance filed 9-19-79 (Register 79, No. 38).
3. Amendment of subsection (b) filed 1 1-14-89 as an emergency pursuant to sec-
tion 9 of chapter 1441 ofthe Statutes of 1988; operative 1 1-14-89 (Register 89,
No. 48). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 3-14-90.
4. Amendment of subsection (b) refiled 3-8-90 as an emergency pursuant to sec-
tion 9 of chapter 1441 ofthe Statutes of 1988; operative 3-13-90 (Register 90,
Nfo. 12). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 7-1 1-90.
5. Certificate of Compliance as to 3-8-90 order transmitted to OAL 7-5-90 and
disapproved 8-6-90 (Register 90, No. 42).
6. Amendment of subsection (b) filed 8-23-90 as an emergency pursuant to sec-
tion 9 of chapter 1441 ofthe Statutes of 1988; operative 8-23-90 (Register 90,
No. 42). A Certificate of Compliance must be transmitted to OAL by 12-21-90
or emergency language will be repealed by operation of law on the following
day.
7. Certificate of Compliance as to 8-23-90 order transmitted to OAL 1 1-20-90
and filed 12-17-90 (Register 91, No. 5).
§ 50175. Denial or Discontinuance Due to Lack of
Information, Noncooperation or Loss of
Contact.
(a) The application shall be denied or eligibility shall be discontinued
under any of the following circumstances:
(1) There is insufficient information available to make an eligibility
determination, after the county department has made a reasonable effort
to obtain the necessary information.
(2) The applicant or person completing the Statement of Facts fails,
without good cause, to provide necessary verification or to cooperate
with the county department in resolving incomplete, inconsistent or un-
clear information on the Statement of Facts.
(3) The beneficiary fails, without good cause, to return a status report
required under Section 50191 (a) or (b).
(4) The applicant or beneficiary fails, without good cause, to partici-
pate in the face-to-face interview in accordance with Section 50157.
(5) The applicant or beneficiary fails, without good cause, to respond
within 10 days to a letter from the county department idenfifying infor-
mation received from the lEVS and requesting further information.
(6) The county department, after reasonable attempts to contact the
applicant or beneficiary, determines that there is loss of contact.
(7) The applicant or beneficiary;
(A) Refuses to assign to the state all rights to medical support and pay-
ments as specified in Section 50185(a)(ll).
(B) Fails to cooperate with the state, county department, and the dis-
trict attorney's office, without good cause, as specified in Section
50771.5 in:
1. Providing information to establish paternity for a child under eigh-
teen years of age bom out of wedlock for whom Medi-Cal is requested;
2. Obtaining medical support and payments; and
Page 331
Register 97, No. 37; 9-12-97
§ 50176
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
3. Identifying and providing information to assist the state, county, or
district attorney in pursuing any third party who is or may be liable to pay
for medical care, services, or support.
In the case of a refusal to assign rights or to cooperate in (B) above, the
parent or caretaker relative will be given the opportunity to withdraw his/
her application. Refusal to withdraw the application shall result in his/her
ineligibility as specified in Section 50379.
(b) A person or family whose eligibility is denied or discontinued for
any of the reasons specified in (a) may:
(1) Reapply at any time, including the original month of application.
(2) Have the denial or discontinuance rescinded by providing evidence
that the person or family had good cause for not meeting the conditions
specified by the county department.
(c) For purposes of this section good cause includes, but is not limited
to:
(1) Failure of the county to provide the beneficiary with the required
status report form or with the information that failure to complete and re-
turn the form may result in discontinuance.
(2) Failure of the postal system to deliver the required status report
forms in a timely manner.
(3) Physical or mental illness or incapacity of the beneficiary and the
authorized representative which precludes their completion or return of
the completed status report form in a timely manner, or which precludes
their participation in the face-to-face interview.
(4) A level of literacy of the beneficiary and the authorized representa-
tive which, in conjunction with other social or language barriers, pre-
cludes the beneficiary and the authorized representative from completing
the status report.
(5) Failure of the county to process properly the submitted Statement
of Facts or status report form.
(6) Unavailability of transportation to the county department for the
face-to-face interview.
(7) A determination by the county department that the applicant or
beneficiary (1) failed to cooperate in obtaining medical support and pay-
ments for himself/herself and for any other individual for whom he/she
is applying; in identifying and providing information to assist the state,
county, and/or district attorney in pursuing any third party who is or may
be liable to pay for medical care, services, and support; and in establish-
ing paternity, but (2) met the good cause criteria specified in Section
50771.5.
NOTE: Authority cited: Sections 10725, 10740 and 14124.5, Welfare and Institu-
tions Code. Reference: Sections 11004, 11050, 14001, 14008.6, 14011, 14012,
14014 and 14016, Welfare and Institutions Code; and 42 Code of Federal Regula-
tions 435.955(c)(2); and 42 C.F.R. Sections 433. 135. 433. 136, 433. 137, 433.138,
433.145, 433.146, 433.147, 433.148 and 435.604.
History
1. Amendment of subsection (b) filed 12-15-77; effective thirtieth day thereafter
(Register 77, No. 51).
2. Amendment filed 9-1-78; effective thirtieth day thereafter (Register 78, No.
35).
3. Editorial correction of Note filed 7-7-83 (Register 83, No. 29).
4. Amendment of subsection (a) filed 7-16-87; operative 7-16-87 pursuant to
Government Code Section 1 1346.2(d) (Register 87, No. 30).
5. New subsections (a)(7)-(a)(7)(B)3. and (c)(7), and amendment of subsecfions
(a), (c)(5) and Note filed 4-16-93 as an emergency; operative 4-16-93 (Regis-
ter 93, No. 16). A Certificate of Compliance must be transmitted to OAL
8-16-93 or emergency language will be repealed by operation of law on the fol-
lowing day.
6. Certificate of Compliance as to 4-16-93 order including amendment of Note
U-ansmitted to OAL 8-13-93 and filed 9-23-93 (Register 93, No. 39).
§ 50176. Discontinuance Due to Death.
Eligibility, shall be discontinued at the end of the month in which a per-
son dies.
§ 50177. Promptness Requirement.
(a) The county department shall complete the determination of eligi-
bility and share of cost as quickly as possible but not later than any of the
following:
(1) Forty-five days following the date the application, reapplication
or request for restoration is filed.
(2) Ninety days following the date the apphcation, reapplication or re-
quest for restoraUon is filed when eligibility depends on establishing dis-
ability or blindness.
(b) The 45- and 90-day periods may be extended for any of the follow-
ing reasons:
(1) The applicant, the applicant's guardian, or other person acUng on
the apphcant's behalf, has for good cause, been unable to return the com-
pleted Statement of Facts, Supplement to Statement of Facts for Retroac-
tive Coverage/Restoration, or necessary verification in time for the
county department to meet the promptness requirement.
(2) There has been a delay in the receipt of reports and information
necessary to determine eligibility and the delay is beyond the control of
either the applicant or the county department.
(c) The determination of eligibility shall be considered complete on
the date the Notice of Action is mailed to the applicant.
NOTE: Authority cited: Sections 10725, 14124.5 and 14154.2(b), Welfare and In-
stitufions Code. Reference: Sections 11052, 11055, 14001, 14011, 14016. and
14154.2(b) Welfare and Insfitutions Code; and 42 Code of Federal Regulations
435.911.
History
1 . Amendment of subsection (b)( I) filed 12- 1 5-77; effective thirtieth day thereaf-
ter (Register 77, No. 51).
2. Amendment filed 8-7-78; effective thirtieth day thereafter (Register 78, No.
32).
3. Amendment of subsection (b) filed 3-7-80 as an emergency; effecfive upon fil-
ing (Register 80, No. 9). A Certificate of Compliance must be transmitted to
OAH within 120 days or emergency language will be repealed on 7-6-80.
4. Certificate of Compliance filed 6-6-80 (Register 80, No. 23).
5. Editorial correction of NOTE filed 7-7-83 (Register 83, No. 29).
6. Change without regulatory effect filed 1-9-91 pursuant to section 100, title 1,
California Code of Regulations (Register 91, No. 8).
§ 50179. Notice of Action — IVIedi-Cal-Only Determinations
or Redeterminations.
(a) County departments shall nofify beneficiaries in writing of their
Medi-Cal-only eligibility or ineligibility, and of any changes made in
their eligibility status or share of cost. This notification shah be called the
"Notice of Action."
(b) The Nouce of Action shall be on a form prescribed by the Depart-
ment and shall include the name and telephone number of the eligibility
worker who completed the eligibility deterinination, and the date the
form was completed. A copy of the Notice of Action shall be placed in
the case file.
(c) The Notice of Acfion shall include the following:
(1) The approval, denial or discontinuance of eligibility, the recision
of a denial or discontinuance, or the change in the share of cost and the
effective date of the action.
(2) The amount of the share of cost, if any, and the amount of the net
nonexempt income used to determine the share of cost.
(3) The reason an acfion is being taken and the law or regulation that
requires the action, if the action is a denial, disconfinuance or increase in
share of cost.
(4) The right to request a State hearing if dissatisfied with:
(A) Any acfion or inacfion by the county department that affects the
applicant's or beneficiary's Medi-Cal eligibility or share of cost, except
as fimited in Secfion 50951(a).
(B) Any action taken by, or on behalf of, the Department that affects
the applicant's or beneficiary's Medi-Cal benefits.
(5) The procedures for requesting a State hearing and the time limits
within which a state hearing must be requested.
(6) The circumstances under which aid will be continued if a hearing
is requested.
(7) A statement, when appropriate, regarding the information or action
necessary to reestablish eligibility or determine a correct share of cost.
(d) The Notice of Action shall be mailed for:
Page 332
Register 97, No. 37; 9-12-97
Title 22
Health Care Services
§ 50183
(1) Adverse actions, at least 10 calendar days prior to the first of the
month in which the action becomes effective, excluding the date of mail-
ing-
(2) Discontinuances or increases in the share of cost which are not ad-
verse actions, in sufficient time to reach the beneficiary by the effective
dale of the action.
(3) All other instances, no later than the date the county department
takes the action.
(e) Duplicate Notices of Action shall be mailed to the administrator of
the long-term care facility in which the applicant or beneficiary resides,
if the applicant or beneficiary or person acting on their behalf has made
such a request.
(f) Conditional notices, which advise applicants or beneficiaries that
ehgibility will be denied or discontinued unless specified actions are tak-
en by the applicants or beneficiaries, shall not be considered to meet the
Notice of Action requirements of (a).
Note. Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 10950, 10951, 11002, 11004, 11052, 11055, 14000,
14005, 14016, 14016.2, 14023, 14023.7 and 14124.90 Welfare and Institutions
Code.
History
1 . Amendments of subsections (a) and (c) filed 6-28-89; operative 7-28-89 (Reg-
ister 89, No. 26). For prior history, see Register 8 1 , No. 2 1 .
2. Amendment of subsection (c)(1), repealer of subsections (c)(4)-(c)(7), and sub-
section renumbering filed 9-10-97; operative 10-10-97 (Register97, No. 37).
§ 501 79.5. Notice of Action— County Cash Assistance
Determinations or Redeterminations Which
Affect County Cash-Based l\/ledi-Cal Eligibility.
(a) Persons who are granted, denied or discontinued from county
cash-based programs shall be notified by the county department, in writ-
ing, of their eligibility or ineligibility for county cash-based Medi-Cal.
Additionally, persons who are discontinued shall be notified of their con-
tinued Medi-Cal eligibility status in accordance with (c).
(b) The form of notification shall be one of the following:
(1 ) The appropriate Notice of Action prescribed by the Department of
Social Services, if the notification regarding Medi-Cal eligibility does
not affect the adequacy of timeliness of the cash assistance or IHSS no-
tice.
(2) A Medi-Cal Notice of Action, if the notification regarding Medi-
Cal eligibility would affect the adequacy of timeliness of the cash assis-
tance or IHSS notice.
(c) A Notice of Action of discontinuance of county cash-based Medi-
Cal shall include notice that one of the following actions has been taken:
(1) A referral for determination of Medi-Cal eligibility under another
program is being made and notification of that determination will follow.
(2) A Medi-Cal-only determination has been made and the specific
results of that determination.
(3) County cash-based Medi-Cal is being discontinued for one of the
reasons stated in Section 50183 and a determination of Medi-Cal-only
eligibility will require a separate application.
(4) A cash grant or IHSS is being discontinued due to failure of the re-
cipient to submit data on current status, via Monthly AFDC Eligibility
and Income Report form or another approved method. An automatic re-
evaluation of Medi-Cal eligibility under any program will be done only
if the data is provided by the effective date of the notice.
(5) Additional information is required to permit completion of a Medi-
Cal-only determination. The information required may include the per-
son's wishes concerning continued Medi-Cal eligibility. The county de-
partment may require that the person provide the information by a
specific date.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 11004, Welfare and Institutions Code.
History
1. New section filed 3-5-81; effective thirtieth day thereafter (Register 81, No.
10).
2. Editorial correction of subsection (c)(4) filed 7-7-83 (Register 83, No. 29).
§ 50179.7. Notice of Action— Medi-Ca! Eligibility of
SSI/SSP Recipients.
(a) The Department of Health Services shall notify persons deter-
mined to be eligible for SSI/SSP by the Social Security Administration
that they are also eligible for Medi-Cal.
(b) The Department of Health Services shall notify persons whose
Medi-Cal eligibility has been discontinued by the Department pursuant
to Section 50183.5 that their public assistance Medi-Cal eligibility has
been discontinued and that the county department will contact them to
assist them with the completion of a Medi-Cal-only application.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Secfions 1 1004 and 14016, Welfare and Institutions Code.
History
1 . New section filed 4-13-81; effective thirtieth day thereafter (Register 81, No.
16).
§ 50180. Action Prior to Denial of Application.
Persons or families denied Medi-Cal eligibility under any program
other than SSI/SSP shall have their circumstances evaluated by the
county department prior to denial. If it appears that eligibility would exist
under any program other than SSI/SSP, the application shall be processed
under that program. The date of application shall be the date of the origi-
nal application.
§ 501 81 . Action Following Denial of an SSI/SSP
Application.
(a) Persons denied SSI/SSP eligibility, who then apply for Medi-Cal
at the county department, shall have their application processed under the
appropriate program. The date of application shall be:
(1) The date of the original application for SSI/SSP for those persons
who apply at the county department within 30 days of receipt of a written
notice of denial of SSI/SSP benefits.
(2) The date the person's completed application form is received by
the county department for those persons who do not apply at the county
department within the 30-day period specified in (1).
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 1 1057, 14001, 14005.4and 14005.7, Welfare and Insti-
tufions Code.
History
1. Editorial correction adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 50182. Corrective Action on Denied Applications.
(a) A denial of an application shall be rescinded in either of the follow-
ing situations:
(1) A fair hearing decision orders such action.
(2) The county department determines that the denial was in error.
(b) Medi-Cal eligibility that results from corrective action taken on a
denied application shall be approved based on the date of the application
that was denied.
§ 50183. Transfer Between Programs.
(a) A person or family who has been receiving Medi-Cal under any
program other than SSI/SSP and whose eligibility is discontinued shall
be evaluated by the county department to determine if Medi-Cal eligibil-
ity exists under any other program. If it appears that eligibility would ex-
ist for:
(1) AFDC regulations pertaining to the appropriate AFDC program
shall be followed in transferring the case and establishing eligibility.
(2) SSI/SSP, the person shall be referred to the Social Security Admin-
istration. This referral shall be documented in the case file. Pending the
SSI/SSP determination, the county department shall determine eligibility
under any other program for which the person may be eligible.
(3) Only Medi-Cal-only the county department shall initiate an intra-
program status change or interprogram transfer to the appropriate aid
category and shall determine eligibility under that aid category. A new
application form is not required.
(b) The county shall not be required to evaluate Medi-Cal eligibility
under another program when a beneficiary has:
(1) Been discontinued due to any of the following:
Page 333
Register 97, No. 37; 9-12-97
§ 50183.5
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
(A) A move out of state.
(B) A move with loss of contact.
(C) Death.
(2) Established Medi-Cal eligibility simultaneously in two or more
different counties or under two or more different programs or identities,
and eligibility was discontinued in all but one county or under all but one
program or identity.
(3) Been discontinued from the program due to noncooperation in sup-
plying information needed to meet cash grant or IHSS eligibility require-
ments, and those same requirements exist for all Medi-Cal-only pro-
grams for which the person may be eligible.
(c) Persons whose SSl/SSP eligibility has been discontinued may ap-
ply for Medi-Cal at the county department.
(J ) A new application shall be completed, unless the family of the per-
son discontinued from SSI/SSP is currently receiving Medi-Cal. In this
case, the request for aid shall then be treated as a request to add a family
member to the Medi-Cal case.
(2) The date of the application shall be the date the completed applica-
tion form is received by the county department.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005 and 14016, Welfare and Institutions Code.
History
1 . Amendment of subsections (a)(1) and (b)(1) filed 12-15-77; effective thirtieth
day thereafter (Register 77, No. 51).
2. Amendment of subsection (a)(]) filed 8-7-78; effective thirtieth day thereafter
(Register 78, No. 32).
3. Amendment filed 3-5-81; effective tliirtieth day thereafter (Register 81, No.
10).
4. Editorial correction of subsection (a)(3) filed 7-7-83 (Register 83, No. 29).
§ 50183.5. Action Following Medi-Cal Discontinuance by
the Department.
(a) The Department shall inform the county department of any ABD
person whose Medi-Cal eligibility as an SSI/SSP PA recipient has been
discontinued because the conditions in (1)(A) and (B) exist.
(1) The county department shall contact the person and assist the per-
son with the completion of an application for Medi-Cal-only pursuant
to Section 50147 when the following conditions exist.
(A) The person has been in long-term care for more than the month
of admission and is expected to remain in the facility for at least 30 days.
(B) The person has nonexempt monthly gross income in excess of
$44.90.
(2) The county department shall advise the Department immediately
that an inappropriate referral has been received when the conditions in
(1) do not exist.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 11004 and 14016, Welfare and Institutions Code.
History
1. New section filed 4-13-81; effective thirtieth day thereafter (Register 81, No.
16).
§ 50184. Referral for Social Services.
(a) The county department shall refer a person or family for social ser-
vices in accordance with Department procedures if it appears that there
is a need for such services.
(b) A referral for social services shall also be made for the following
needs related to the CHDP Program unless other arrangements have been
made with the local CHDP Program:
(1) Assistance in:
(A) Arranging for screening services for persons under 21 years of age
under the CHDP Program.
(B) Overcoming fears of medical treatment.
(C) Understanding the importance of preventive health.
(2) Arranging for transportation, child care or other services to enable
the individual to take advantage of CHDP benefits.
(c) The county department shall notify all applicants who are pregnant,
breastfeeding or postpartum women as defined in Section
50157(f)(5)(A) or parents/guardians of children under the age of five of
the availability of benefits provided by the Special Supplemental Food
Program for Women, Infants and Children (WIC) program by giving the
applicant a WIC brochure.
(1) An oral explanation of WIC benefits shall be given to those individ-
uals who are unable to read.
(2) Referral shall be made to the WIC program if there appears to be
aneed for such services forall such individuals, as specified in subsection
(c) above.
(d) The Department of Health Services, no less frequently than annual-
ly, shall provide written notification concerning the WIC program to all
Medi-Cal beneficiaries who might be pregnant, breastfeeding, or post-
partum as defined in Section 50157(f)(5)(A), or a parent/guardian of a
child under the age of five.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 10001, 10051, 14000, 14001 and 14001.1, Welfare and
Institutions Code; Title 42, United States Code, Sections 1396a(a)(] 1), (51), (52)
and (53); Title 42, Code of Federal Regulafions, Section 431.635; and Section
1902(a) of the Social Security Act.
History
1. Editorial correction adding NOTE filed 7-7-83 (Register 83, No. 29).
2. New subsections (c)-(d) and amendment of NOTE filed 8-22-96; operative
9-21-96 (Register 96, No. 34).
§ 50185. Applicants' and Beneficiaries' General
Responsibilities.
(a) As a condition of eligibility, applicants and beneficiaries, and per-
sons acting on behalf of such applicants or beneficiaries, shall:
(1) Complete and participate in the completion of all documents re-
quired in the application process or in the determination of continuing eli-
gibility.
(2) Make available to the county department all documents needed to
determine eligibility and share of cost, as specified in Sections 50167
through 50172.
(3) Report all facts that are pertinent to the determination of eligibility
and share of cost.
(4) Report the following facts to the county department that may affect
the determination of eligibility and share of cost within 10 calendar days
following the date the change occurred:
(A) Change of address.
(B) Change in property or income.
(C) Change in family composition.
(D) Change in other health care coverage.
(5) The requirement to report to the county department and to any pro-
vider of health care services any existing contractual or other legal en-
titlement to other health care coverage; and, to fully utilize other health
care coverage before using Medi-Cal benefits. The information to be re-
ported shall include the name of the other health care coverage, policy
and group numbers, and termination date, if available.
(6) Responsibility to report to the county department the availability
of any option to obtain other health care coverage through, but not limited
to, the beneficiary's employer, labor union, trust fund, spouse or parent
and to provide information necessary for the Department to determine if
it would be cost effective for the Department to pay the premium to obtain
or continue other health coverage.
(7) The requirement to apply for, and/or retain any available other
health care coverage when there is no premium cost to the beneficiary.
Compliance with this requirement shall be a condition of coverage for
Medi-Cal covered benefits to the party responsible for the acquisition or
continuance of such health care coverage, and shall not interfere with
Medi-Cal benefits provided to the remaining family unit.
(8) Cooperate fully in any investigation that may be required for quali-
ty control.
(9) Report, apply for, and utilize all other health care coverage avail-
able to the individual or family group in accordance with Section 50763.
(10) Complete Medi-Cal status reports in accordance with Section
50191 (a) or (b).
Page 334
Register 97, No. 37; 9-12-97
Title 22
Health Care Services
§ 50185.5
(11) Promptly notify the county department which initially established
Medi-Ca] eligibility of any changes in residence from one county to
another within the state and apply for a redetermination of eligibility
within the new county of residence. "Apply for a redetermination of eli-
gibility," as used in this section, is defined as any clear expression to the
county department, whether verbal or written, that the beneficiary is liv-
ing in the county and wishes to continue receiving Medi-Cal.
(1 2) Cooperate with the state, county department, and the district attor-
ney's office in all of the following:
(A) Establishing paternity for a child under eighteen years of age born
out of wedlock for whom Medi-Cal is requested.
(B) Obtaining medical support and payments; and
(C) Providing all of the information requested by the state, county de-
partment, and district attorney's office, which is necessary to identify, lo-
cate, and pursue any third party, including an absent parent, who is or
may be liable for medical care and services or support.
( 13) In the case of a woman who is pregnant, or a child who was born
out of wedlock or whose parent is absent from the home, at the conclusion
of the 60-day postpartum period:
(A) Complete the Child Support Questionnaire (CA 2.1 Q Support
Questionnaire, Revised 3/93), the Child/Spousal and Medical Support
Notice and Agreement (CA 2.1 Notice and Agreement, Revised 12/92),
and any additional forms specified in the district attorney and approved
by the Department of Health Services;
(B) Appear at the county department and at the office of the district at-
torney to provide information, when requested;
(C) Provide to the county department and to the district attorney all in-
formation which is relevant to the case.
(D) Appear as a witness in court or in other hearings and proceedings
relating to (9) and (10) above.
(14) Assign to the state all rights to any medical support and to pay-
ments for medical care from any third party, as specified in Section
50157.
(b) Applicants and recipients whose eligibility is determined by the
Social Security Administration shall, as a condition of eligibility, comply
with subsections (a)(9), (a)(10), and (a)(l 1) above, and report to the De-
partment and utilize all other health care coverage available to them in
accordance with Section 50763.
(c) If the Statement of Facts has been completed and signed by some-
one other than the applicant or beneficiary, the responsibilities stated in
(a) and (b) shall rest with that person as well as with the applicant or bene-
ficiary.
(d) The county shall assist the applicant or beneficiary as necessary in
meeting the requirements of this section.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 10740, 11004(a) and (b), 11053, 14001, 14008.6,
1 40 1 1 , 1 40 1 6 and 1 4 1 00. 1 , Welfare and Institutions Code ; and 42 C.F.R. Sections
433.135, 433.136, 433.137, 433.138, 433.145, 433.146, 433.147, 433.148 and
435.604.
History
1. Amendment of subsection (a)(2) filed 12-15-77; effective thirtieth day thereaf-
ter (Register 77, No. 51).
2. New subsection (a) (7) filed 9-1-78; effective thirtieth day thereafter (Register
78, No. 35).
3. New subsection (a)(8) filed 6-14-84; designated effective 7-1-84 pursuant to
Government Code section 11346.2(d) (Register 84, No. 24).
4. Amendment of secfion heading, subsecdons (a), (a)(6) and (b) and Note filed
4-16-93 as an emergency; operative 4-16-93 (Register 93, No. 16). A Certifi-
cate of Compliance must be transmitted to OAL 8-16-93 or emergency lan-
guage will be repealed by operation of law on the following day.
5. Certificate of Compliance as to 4-16-93 order including amendment of Note
transmitted to OAL 8-13-93 and filed 9-23-93 (Register 93, No. 39).
6. Amendment of subsection (a)(4), new subsections (a)(4)(A)-(a)(7), and subsec-
tion renumbering filed 9-10-97; operative 10-10-97 (Register 97, No. 37).
§ 50185.5. Medi-Cal Managed Care Plan Assigned
Enrollment Prior to Two-Plan Model
Implementation or for Geographic Areas Not
Designated for Two-Plan Model
Implementation.
(a) This section applies to geographic areas specified by the director,
which may include geographic areas designated for implementation of
the two-plan model as defined in section 53810(n) prior to implementa-
tion of the two-plan model, and geographic areas not designated for two-
plan model implementation. This section applies to aid categories speci-
fied by the director, pursuant to Welfare and Institutions Code Section
14016.5 and 14087.305.
(b) The following definitions apply to this section:
(1 ) Affiliate means an existing Medi-Cal managed care plan that has
a written agreement to become a subcontractor to the local initiative or
the commercial plan when the local initiative or commercial plan com-
mences operation, or an entity that has been awarded the local initiative
or commercial plan contract under the Two-Plan Model and is an exist-
ing Medi-Cal prepaid health plan contractor that is authorized under its
Medi-Cal prepaid health plan contract to operate in the service area to
which the plan has been awarded the commercial plan or local initiative
contract under the Two-Plan Model.
(2) Assignment means the action taken by the health care options con-
tractor to enroll an eligible beneficiary or an eligible family group into
aMedi-Cal managed care plan when the beneficiary fails to select a man-
aged care plan and does not provide a written certification of an estab-
lished patient-provider relationship.
(3) Authorized affihate means any existing Medi-Cal prepaid health
plan that has been awarded the local initiative or commercial plan con-
tract under the Two-Plan Model, or is an affiliate that has been autho-
rized by the department to receive assignments after a local initiative or
commercial plan has submitted a written request to the department that
assignments be made to that affiliate.
(4) Commercial plan means a prepaid health plan in a designated geo-
graphic area awarded a contract by the department pursuant to sections
53800(b)(1).
(5) Commercial plan enrollment maximum means the enrollment lev-
el established by the department pursuant to section 53820(b).
(6) Confirmed conditional start date means the date established by the
department on which a local initiative or commercial plan is authorized
to begin operation under the Two Plan Model, subject to the local initia-
tive or commercial plan fulfilling the conditions specified by the depart-
ment at the time the confirmed conditional start date is given by the de-
partment.
(7) CP/LI ratio means the total enrollment of the commercial plan, or
if the commercial plan is not operational, the combined total enrollment
of the commercial plan affiliates, DIVIDED by the combined total enrol-
lment of the local initiative affihates. The source of the enrollment totals
is the department's monthly Medi-Cal managed care capitation report.
(8) Fee-for-service managed care program means a program operated
in a designated geographic area by an entity contracting with the Depart-
ment under which services continue to be provided on a fee-for-service
basis, but each Medi-Cal beneficiary is provided with a primary care pro-
vider who coordinates the beneficiary's Medi-Cal health care.
(9) Health care options contractor means the entity contracting with
the department to provide appUcants and beneficiaries with information
on the available options to receive Medi-Cal benefits and to process
applicant and beneficiary enrollment choices or assignments in desig-
nated geographic areas.
(10) Health care options presentation means a presentation in-person
or by mail to Medi-Cal applicants and beneficiaries which provides in-
formation on the Medi-Cal managed care plans and fee-for-service op-
Page 335
Register 97, No. 37; 9-12-97
§ 50185.5
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
tions available within the designated geographic area in which the apph-
cant or beneficiary resides.
(iJ) Local initiative means a prepaid health plan awarded a contract
by the department pursuant to sections 53800(b)(2) and 53810(h).
(12) Local initiative enrollment minimum means the total number of
Medi-Cal beneficiaries in the mandatory aid categories in the designated
geographic area less the maximum enrollment level established pursuant
to section 53820 of the commercial plan.
(13) Operational means a managed care plan is providing covered ser-
vices to enrolled Medi-Cal beneficiaries and is entitled to receive capita-
tion payments from the department.
(c) Applicants and beneficiaries shall be informed by the county wel-
fare department of the availability of health care options presentations
which explain the options for receiving Medi-Cal benefits and the obli-
gation of the applicants and beneficiaries to attend a presentation. For
beneficiaries who do not attend a health care options presentation, the de-
partment shall mail information explaining the beneficiary's health care
options.
( 1 ) The county welfare department shall inform applicants and benefi-
ciaries of the availability of health care options presentations at the time
of their initial eligibility and annual redetermination in the following geo-
graphic areas:
(A) Areas designated for the two-plan model, when:
1 . only the commercial plan is operational; or
2. only the local initiative is operational; or
3. the department intends to award two commercial plan contracts and
no local initiative contract, and only one commercial plan is operational.
(B) Areas not designated for the two-plan model.
(2) If, within the same geographical area, the local initiative is sched-
uled to become operational prior to the date the commercial plan is ex-
pected to become operational, the local initiative may submit a written
request to the department that the department include all existing benefi-
ciaries in the mandatory aid categories in the health care options notifica-
tion process.
(d) At the health care options presentation or by mail, the department
shall provide to the applicant or beneficiary information on Medi-Cal
managed care plans operating within the geographic area in which the
applicant or beneficiary resides.
(e) Each applicant or beneficiary shall submit in writing to the health
care options contractor a choice to enroll in a Medi-Cal managed care
plan or shall certify in writing that he or she has an established patient-
provider relationship either:
(1) within 30 days of the applicant's or beneficiary's attendance at a
health care options presentation; or,
(2) if the applicant or beneficiary does not attend a health care options
presentation prior to the postmark date on which the health care options
materials were mailed to the applicant or beneficiary, within 30 days of
the postmark date of the mailed health care options materials.
(t) The health care options contractor shall assign beneficiaries failing
to comply with the requirements of subsection (e) to an available Medi-
Cal managed care plan that has capacity to accept new beneficiaries and
that has a primary care service site serving the postal ZIP code area in
which the beneficiary resides. To the extent possible, a beneficiary shall
not be assigned to a different Medi-Cal managed care plan than other
members of the same family group.
(g) In geographic areas designated for health care to be provided under
the two-plan model, if more than one Medi-Cal managed care plan
meets the conditions in (f), assignments shall be made as follows:
(1) If the local initiative is operational, all assignments will be directed
to the local initiative until it reaches the local initiative enrollment mini-
mum.
(2) If the local initiative is operational and has attained its enrollment
minimum and the commercial plan is not operational but has authorized
affiliates, one of every two assignments will be directed to the local initia-
tive and one will be directed to an authorized affiliate of the commercial
plan. Assignments to the commercial plan's affiliates will be evenly dis-
tributed among all authorized affiliates of the commercial plan. Assign-
ments to the authorized commercial plan affiliates will continue until
their combined enrollment total reaches the commercial plan enrollment
maximum, at which time assignments to authorized commercial plan af-
filiates will be discontinued. Enrollment in the local initiative and com-
mercial plan affiliates will be reviewed on a monthly basis. If the local
initiative's enrollment falls below the local initiative's enrollment mini-
mum, all assignments will be directed to the local initiative as needed to
restore it to its enrollment minimum. After the local initiative has been
restored to its enrollment minimum, assignments to the authorized com-
mercial plan affiliates will be resumed as provided above until the com-
mercial plan affiliates' combined enrollment total reaches the commer-
cial plan enrollment maximum, at which time assignments to authorized
commercial plan affiliates will be discontinued. If the commercial plan
does not have any authorized affiliates, all assignments will be directed
to the local initiative.
(3) If the commercial plan is operational and the local, initiative is not
operafional but has authorized affiliates, and the combined total
enrollment of the local initiative affiliates is less than the total enrollment
of the commercial plan, assignments will be made as follows:
(A) If the CP/LI rafio is 1 .0 or less, one of every two assignments will
be directed to an authorized affiliate of the local initiative and one assign-
ment will be directed to the commercial plan.
(B) If the CP/LI ratio is greater than 1 .0 but less than or equal to 2.0,
two of every three assignments will be directed to the authorized affili-
ates of the local initiative and one assignment will be directed to the com-
mercial plan.
(C) It the CP/LI rafio is greater than 2.0 but less than or equal to 3.0,
three of every four assignments will be directed to the authorized affili-
ates of the local initiafi ve and one assignment will be directed to the com-
mercial plan.
(D) If the CP/LI rafio is greater than 3.0, four of every five assignments
will be directed to the authorized affiliates of the local initiative and one
assignment will be directed to the commercial plan.
(E) For (g)(3)(A), (B), (C) and (D), assignments to the authorized local
initiafive affiliates will be evenly distributed among all authorized affili-
ates of the local initiative.
(F) Once (g)(3)(B), (C), or (D) have been applied, and the CP/LI rafio
reaches 1.0 or less, until 90 days prior to the Local Inifiative's confirmed
conditional start date, one of every two assignments will be directed to
an authorized affiliate of the local initiative and one assignment will be
directed to the commercial plan. No further use of the CP/LI rafio will
be made to determine assignments. When the commercial plan reaches
its enrollment maximum, further assignments to the commercial plan
will be discontinued. Enrollment totals in the commercial plan and the
combined enrollment total for the local initiafive affiliates will be re-
viewed on a monthly basis. If enrollment falls below the commercial
plan enrollment maximum, assignments to the commercial plan will be
resumed with the commercial plan receiving one of every two assign-
ments until the commercial plan reaches the commercial plan enrollment
maximum.
(G) Beginning 90 days prior to a local inifiative's confirmed condition-
al start date, all assignments will be made to the authorized affiliates of
the local initiative. These assignments will be evenly distributed among
aU authorized affiliates of the local initiative. When enrollment in the af-
filiates of the local initiative reaches the local initiative's minimum enrol-
lment, one of every two assignments will be directed to an authorized af-
filiate of the local inifiative and one assignment will be directed to the
commercial plan. Assignments to the authorized affiliates of the local
inifiafive will be evenly distributed among all authorized affiliates of the
local initiative. Assignments to the commercial plan will continue until
the enrollment total of the commercial plan equals the commercial plan
enrollment maximum, at which time assignments to the commercial plan
will be discontinued. The enrollment total of the commercial plan and
Page 336
Register 97, No. 37; 9-12-97
Title 22
Health Care Services
§ 50185.5
•
the combined enrollment total for the affiliates of the local initiative will
be reviewed on a monthly basis. If the combined enrollment of the affili-
ates of the local initiative falls below the local initiative's enrollment
minimum, all assignments will be directed to the authorized affiliates of
the local initiative as needed to restore the combined enrollment in affili-
ates of the local initiative to the local initiative enrollment minimum. Af-
ter enrollment in the alTihates of the local initiative has been restored to
its enrollment minimum, assignments to the commercial plan will be re-
sumed as provided above until the commercial plan's enrollment reaches
the commercial plan enrollment maximum, at which time assignments to
the commercial plan will be discontinued.
(4) If the commercial plan is operational, and the local initiative is not
operational but has authorized affiliates, and the combined enrollment of
the local initiative affiliates is equal to or greater than the enrollment in
the commercial plan, one of every two assignments will be directed to an
authorized affiliate of the local initiative and one assignment will be di-
rected to the commercial plan. When the commercial plan reaches its en-
rollment maximum, further assignments to the commercial plan will be
discontinued. Enrollment totals in the commercial plan and the com-
bined enrollment total for the local initiative affiliates will be reviewed
on a monthly basis. If enrollment falls below the commercial plan
enrollment maximum, assignments to the commercial plan will be re-
sumed with the commercial plan receiving one of every two assignments
until the commercial plan reaches the commercial plan enrollment maxi-
mum.
(5) If the commercial plan is operational, and the local initiative is not
operational and the local initiative does not have any authorized affili-
ates, all assignments will be directed to the commercial plan. When the
commercial plan reaches its enrollment maximum, further assignment to
the commercial plan will be discontinued. Enrollment in the commercial
plan will be reviewed on a monthly basis. If enrollment falls below the
commercial plan enrollment maximum, assignments to the commercial
plan will be resumed with the commercial plan receiving all assignments
until the commercial plan reaches its enrollment maximum.
(6) If neither the local initiative nor commercial plan is operational, but
either one or both has authorized affiliates, assignment shall be as fol-
lows:
(A) If the local initiative does not have any authorized affiliates and
the commercial plan has authorized affiliates, all assignments will be di-
rected to the commercial plan's authorized affiliates. When the com-
bined total enrollment of the commercial plan's affiliates reaches the
commercial plan maximum, further assignments to the commercial
plan's authorized affiliates will be discontinued. Enrollment in the com-
mercial plan's affiliates will be reviewed on a monthly basis. If the com-
bined total enrollment of the commercial plan's affiliates falls below the
commercial plan maximum, assignments will be resumed until the com-
bined enrollment in the commercial plan's affiliates reaches the commer-
cial plan maximum.
(B) If the local initiative has authorized affiliates and the commercial
plan does not have authorized affiliates, all assignments will be directed
to the authorized affiliates of the local initiative.
(C) If the local initiative has not been given a confirmed conditional
start date by the department, and the combined total enrollment of the lo-
cal initiative affiliates is less than the combined total enrollment of the
commercial plan affiliates, until the combined total enrollment of the lo-
cal inifiative affiliates is equal to or greater than the combined total
enrollment of the commercial plan affiliates, assignments will be made
as follows:
1. If the CP/LI ratio is 1.0 or less, one of every two assignments will
be directed to the authorized affiliates of the local initiative and one as-
signment will be directed to an authorized affiUate of the commercial
plan.
2. If the CP/LI ratio is greater than 1 .0 but less than or equal to 2.0, two
of every three assignments will be directed to the authorized affiliates of
the local inifiafive and one assignment will be directed to an authorized
affiliate of the commercial plan.
3. If the CP/LI ratio is greater than 2.0 but less than or equal to 3.0, three
of every four assignments will be directed to the authorized affiliates of
the local inifiative and one assignment will be directed to an authorized
affiliate of the commercial plan.
4. If the CP/LI ratio is greater than 3.0, four of every five assignments
will be directed to the authorized affiliates of the local initiative and one
assignment will be directed to an authorized affiliate of the commercial
plan.
5. For (g)(6)(C)(l), (2), (3) and (4), assignments to the authorized affil-
iates of the local initiaUve will be evenly distributed among all authorized
affihates of the local initiative and assignments to authorized affiliates of
the commercial plan will be evenly distributed among all authorized af-
filiates of the commercial plan.
6. Once (g)(6)(C), (2), (3) or (4) have been applied, and the CP/LI ratio
reaches l.O or less, until 90 days prior to the local inifiative's confirmed
conditional start date, one of every two assignments will be directed to
an authorized affiliate of the local initiative and one assignment will be
directed to an authorized affihate of the commercial plan. No further use
of the CP/LI rafio will be made to determine assignments. Assignments
to the authorized affiliates of the local initiative will be evenly distributed
among all authorized affiliates of the local inifiative and assignments to
the authorized affihates of the commercial plan will be evenly distributed
among all authorized affiliates of the commercial plan. Assignments to
the authorized affiliates of the commercial plan will continue until the
combined enrollment total of the affiliates of the commercial plan equals
the commercial plan enrollment maximum, at which fime assignments to
authorized affiliates of the commercial plan will be discontinued. In the
case of an affiliate that has affiliated with both the local initiative and the
commercial plan, the total enrollment of that affiliate will be included in
the combined commercial plan enrollment totals to determine if the com-
mercial plan enrollment maximum has been reached. The combined en-
rollment total for the affiliates of the commercial plan and combined total
for the affiliates of the local initiative will be reviewed on a monthly ba-
sis. If the local inifiative's enrollment falls below the local initiative's
enrollment minimum, all assignments will be directed to the local initia-
Uve as needed to restore it to its enrollment minimum. After the local ini-
fiative has been restored to its enrollment minimum, assignments to the
authorized affiliates of the commercial plan will be resumed as provided
above unfil the combined enrollment of the authorized affiliates of the
commercial plan reaches the commercial plan enrollment maximum, at
which fime assignments to the authorized affiliates of the commercial
plan will be disconfinued.
(D) If the combined enrollment of the affiliates of the local initiafive
is equal to or greater than the combined enrollment of the affihates of the
commercial plan, one of every two assignments will be directed to an au-
thorized affiliate of the local inifiafive and one assignment will be di-
rected to an authorized affiliate of the commercial plan. Assignments to
the authorized affiliates of the local initiative will be evenly distributed
among all authorized affiliates of the local inifiafive, and assignments to
the authorized affiliates of the commercial plan will be evenly distributed
among all authorized affiliates of the commercial plan. Assignments to
the authorized affiliates of the commercial plan will continue until the
combined enrollment total of affiliates of the commercial plan equals the
commercial plan enrollment maximum, at which time assignments to the
authorized affiliates of the commercial plan will be discontinued. In the
case of an affiliate that has affiliated with both the local initiative and the
commercial plan, the total enrollment of that affiliate will be included in
the combined commercial plan enrollment totals to determine if the com-
mercial plan enrollment maximum has been reached. The combined en-
rollment total for the affiliates of the commercial plan and combined total
for the affiliates of the local inifiafive will be reviewed on a monthly basis.
If enrollment falls below the commercial plan enrollment maximum, as-
Page 336.1
Register 97, No. 37; 9-12-97
§ 50185.5
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
signments to the authorized affiliates of the commercial plan will be re-
sumed with the commercial plan receiving one ofevery two assignments
until the combined enrollment of the affiliates of the commercial plan
reaches the commercial plan enrollment maximum.
(E) Beginning 90 days prior to a local initiative's confirmed condition-
al start date, all assignments will be made to the authorized affiliates of
the local initiative. These assignments will be evenly distributed among
all authorized affiliates of the local initiative. When enrollment in the af-
fihates of the local initiative reaches the local initiative's minimum
enrollment, one of every two assignments will be directed to an autho-
rized affiliate of the local initiative and one assignment will be directed
to an authorized affiliate of the commercial plan. Assignments to the au-
thorized affiliates of the local initiative will be evenly distributed among
all authorized affiliates of the local initiative and assignments to the au-
thorized affiliates of the commercial plan will be evenly distributed
among all authorized affiliates of the commercial plan. Assignments to
the authorized affiliates of the commercial plan will continue until the
combined enrollment total of the affiliates of the commercial plan equals
the commercial plan enrollment maximum, at which time assignments to
authorized affiliates of the commercial plan will be discontinued. In the
case of an affiliate that has affiliated with both the local initiative and the
commercial plan, the total enrollment of that affihate will be included in
the commercial plan's enrollment totals to determine if the commercial
plan enrollment maximum has been reached. The combined enrollment
total of the affiliates of the commercial plan and combined enrollment to-
tal for the affiliates of the local initiative will be reviewed on a monthly
basis. If enrollment falls below the commercial plan enrollment maxi-
mum, assignments to the authorized affiliates of the commercial plan will
be resumed with one ofevery two assignments directed to the authorized
affiliates of the commercial plan until the combined enrollment of the af-
filiates of the commercial plan reaches its enrollment maximum. If the
commercial plan does not have any authorized affiliates, all assignments
will be directed to the authorized affiliates of the local initiative.
(7) Where the department awards two commercial plan contracts and
no local initiative contract, assignment shall be as follows:
(A) If neither commercial plan is operational, assignments will be
evenly distributed among authorized affiliates of the two commercial
plans. When the combined total enrollment of a commercial plan's affili-
ates totals one-half of the mandatory enrollment population, assign-
ments will cease for the authorized affiliates of that plan. In the case of
an affiliate that has affiliated with both commercial plans, the total enrol-
lment of this affiliate will be equally divided for purposes of computation
of the enrollment total to determine when assignments will cease.
(B) If a single commercial plan is operational, assignments will be
evenly distributed among the operational commercial plan and the autho-
rized affiliates of the nonoperational commercial plan. Assignments to
the authorized affiliates of the nonoperational commercial plan will be
evenly distributed. When the total enrollment of the single operational
commercial plan or the combined total enrollment of the authorized affil-
iates of the nonoperational commercial plan equals one-half of the man-
datory enrollment in the designated geographic area, assignments will
cease for that plan. In the case of an affiliate that has affiliated with both
the operational and nonoperational commercial plan, the total enrollment
of that affihate will be equally divided for purposes of computation of the
enrollment total to determine when assignments will cease.
(8) If both the local initiative and the commercial plan become opera-
tional in a geographic area prior to the implementation of mandatory en-
rollment of beneficiaries in the two plan model, assignments will be di-
rected to the local initiative until it reaches its enrollment minimum, then
assignments will be evenly distributed between the local initiative and
the commercial plan. No assignments will be made to other Medi-Cal
managed care plans. When the commercial plan reaches its enrollment
maximum, further assignment to the commercial plan will be discontin-
ued. Enrollment in the local initiative and commercial plan will be re-
viewed on a monthly basis. If the local initiative's enrollment falls below
the local initiative's enrollment minimum, all assignments wih be di-
rected to the local initiative as needed to restore it to its enrollment mini-
mum. After the local initiative has been restored to its enrollment mini-
mum, assignments to the commercial plan will be resumed as provided
above until the commercial plan's enrollment reaches the commercial
plan enrollment maximum, at which time assignments to the commercial
plan will be discontinued.
(9) This is a graphic presentation that illustrates the requirements set
forth in secuons (g)(1), (g)(2), (g)(3), (g)(4), (g)(5), (g)(6) and (g)(8):
Page 336.2
Register 97, No. 37; 9-12-97
ore
LI is not
LI is not Operadona) but bas Autfiorized Affiliates A LI does
LI widi Authorized
LI is Operational:
LI is Operational:
Opcrationa] and
NOT have a Confirmed ConditionaJ Start Date
AflUiates, 8t
LI Enrollment < LI
LI Enrollment >_ LI
has NO
Beginning 90 days
Minimum
Minimum
Authorized
prior to Confunud
Affiliates
Cond'l Start Date
CP is not
No assignments.
(gK6KB).
(g)(6)(B) &
(gXl).
(gK2).
Operational and has
All assignments to the authorized affiliates of the LI.
(gX6KE).
All assignments to
All assignments to
NO Authorized
All assignments to
the LI,
the LI.
AfTiliates
tfic autfa. affiliates of
theLL
CP is not
(gK6KA).
(g)(6)(C).
(gK6KE). AU
(g)(1)- All
(gK2). lof2
Operational hut has
All assignments to
I . IfCP/U ratio ♦ <^ /. 1 of 2 assignments to the
assignments to auth.
assignments to the LI
assignments to the
Authorized Affiliates
authorized
authorized affiliates of the LI.
affiliates of the LI
until it reaches die
LI.
affiliates of CP.
2. If CP/U ratio >1 and <_ 2. 2 of 3 assignmente to the
until it reaches the
LI Min. After the
authorized affiliates of the LI.
LI Min. After LI
LI Min is reached
3. If the CP/U ratio >2 but <_ S, 3 of 4 assignments to the
Min. is reached then
then 1 of 2
authorized affiliates of the LI.
1 of 2 assignments to
assignments to LI.
4. If the CP/U ratio > J, 4 of 5 assignments to the
authorized affiliates of the LI.
6. If the combined enrollment of LI affiliates = combined
CP affiliate enrollment, then 1 of 2 assignments to the
authorized affiliates of the LI.
the authorized
affdiates of the LI.
CP is Operational:
{g)(5).
(g)(3).
(g)(3KG). All
(g)(1). All
(g)(8). lof2
Enrollment is < CP
All assignments to
(A) If CP/U ratio • ^ 7, I of 2 assignments to the
assignments to the
assignments to the LI
assignments to the
Mu.
CP.
audiorized affiliates of the LI.
auth. affiliates of die
undl it reaches the
LI.
(B) If CP/U ratio >I and <_2, 2 of 3 assignments to the
LI until it reaches
LI Min. After the
authorized affiliates of the LI..
the LI Min. After LI
LI Min is reached
(C) If the CP/U ratio >2 />itf <_ i, 3 of 4 assignments to the
Min. is reached then
then 1 of 2
authorized affiliates of the LI..
1 of 2 assignments to
assignments to LI.
(D) If the CP/U ratio >i, 4 of 5 assignments to the
the authorized
authorized affiliates of the LI.
affiliates of the LI.
(F) If die combined enrolhoent of the LI affdiates = CP
enrollment, then 1 of 2 assignments to the authorized
affiliates of the LI.
CP Operational:
(g)(5):
(gK3KF) & (g)(4). All assignments to the authorized afTiliates of
(g)(3KG). All
(g)(8). All
(gK8). All
EmoUment is ^ CP
No assignments.
the LI.
assignments to auth.
assignments to LI.
assignmenu to LI.
JMax.
affiliates of the LI.
• CP/LI ratio means the
total enrollment of ttie
commercial plan, or if the commercial plan is not operational the combined total enrollment ot the commercial plan aftuiatcs. DIViUbL) by the
combined total enrollment of the local initiative affiliates.
§ 50186
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
(h) In geographic areas not designated for two-plan model implemen-
tation, if the department contracts for a fee-for-service managed care
program, assignments will be directed to the fee-for-service managed
care contractor as long as the contractor has an available capacity. In oth-
er geographic areas, assignments will be evenly distributed among
Medi-Cal managed care plans which have been approved by the depart-
ment to participate in the assignment process and have available enrol-
lment capacity consistent with the growth limits pursuant to section
53830.
(i) The health care options contractor shall notify the beneficiary in
writing of the beneficiary ' s assignment to a Medi-Cal managed care plan
at least ten working days prior to the submission of the assignment docu-
ments to the department for processing. The notice shall contain the name
of the Medi-Cal managed care plan to which the beneficiary is assigned;
the conditions defined in subdivisions (j)(l), (2) and (3); and the time
frame for advising the health care options contractor if the assignment is
not appropriate or if the beneficiary wishes to enroll in a different Medi-
Cal managed care plan or certify to a patient-provider relationship.
(i) An assignment is not appropriate when:
(1) The time and distance a beneficiary is required to travel to obtain
primary care services from his or her residence exceeds the normal prac-
tice for the commum'ty or 30 minutes or 10 miles, whichever is greater.
(2) Public transportation is not available to the primary care site, unless
the managed care plan to which the beneficiary is assigned provides
transportation for outpatient services. This criteria will not apply to the
designated fee-for-service managed care program geographic areas
where public transportation to Medi-Cal services has not historically
been available to the beneficiary.
(3) Culturally and linguistically appropriate services are not available
to the beneficiary.
(k) The beneficiary may notify the health care options contractor that
the assignment meets one or more of the conditions in subdivisions (j)(l),
(2), or (3) or the beneficiary requests enrollment in another Medi-Cal
managed care plan. The beneficiary may also certify to a patient-provid-
er relationship. The notice from the beneficiary shall be in writing and
state, if apphcable, the specific condition(s) making the assignment inap-
propriate and the desired action by the health care options contractor.
(1) For such notices from beneficiaries received within ten working
days of the postmark date of the notice of assignment from the health care
options contractor, the health care options contractor shall respond by ac-
cepting the patient-provider certification, if provided, or by enrolling the
beneficiary in another Medi-Cal managed care plan of his or her choice.
(2) For such notices from beneficiaries received after the tenth work-
ing day from the postmark date of the notice of assignment from the
health care options contractor, the health care options contractor shall as-
sist the beneficiary to disenroU from the assigned Medi-Cal managed
care plan and then either accept the patient-provider certification or en-
roll the beneficiary in another Medi-Cal managed care plan of his or her
choice.
(3) If the beneficiary notifies the health care options contractor that the
assignment is inappropriate because one or more of the conditions de-
scribed in subdivisions (j)(l), (2), and (3) exist, and if another Medi-Cal
managed care plan within the geographic area cannot provide for an ap-
propriate assignment in relation to the conditions in (j){\), (2) and (3), or
if another Medi-Cal managed care plan within the geographic area can
provide for appropriate assignment in relation to the conditions in (j)(l),
(2) and (3), but does not have available capacity, the beneficiary may
elect to obtain benefits by receiving a fee-for-service card whether or not
the beneficiary has certified to a patient-provider relationship.
Note- Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14016.5, 14016.6 and 14087.305, Welfare and Institu-
tions Code.
History
1. New section filed 7-10-95; operative 7-10-95. Submitted to OAL for printing
only pursuant to section 147, SB 485 (Ch. 722/92) (Register 95, No. 28).
2. Amendmenl of section filed 6-26-96; operative 6-26-96. Submitted to OAL
for printing only pursuant to Section 1 47 SB 485 (Ch. 722/92) (Reaister 96, No.
27).
3. Amendment filed 8-30-96; operative 8-30-96. Submitted to OAL for printing
only (Register 96, No. 36).
§ 50186. Unconditionally Available Income.
(a) An applicant or beneficiary shall, as a condition of Medi-Cal eligi-
bility, take all actions necessary to obtain unconditionally available in-
come. This includes applying for such income and cooperating in supply-
ing the information requested by the agency making the award
determination.
(b) Income shall be considered unconditionally available if the appli-
cant or beneficiary has only to claim or accept the income. Such income
includes, but is not limited to:
(1) Disability insurance benefits.
(2) Benefits available to veterans of military service.
(3) OASDI benefits.
(4) Unemployment insurance benefits.
(c) Public assistance benefits shall not be considered unconditionally
available income.
(d) Only the person who refuses to apply for and accept unconditional-
ly available income shall be rendered ineligible by such refusal.
NOTE; Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4 and 14005.7, Welfare and Institutions Code.
History
1. New section filed 8-8-80; effective thirtieth day thereafter (Register 80, No.
32).
§ 50187. Social Security Numbers and Health Insurance
Claim Numbers.
(a) Each applicant or beneficiary shall, as a condition of eligibility for
full Medi-Cal benefits, obtain and provide to the county department a
Social Security Number (SSN) and, if eligible, a Social Security Health
Insurance Claim (HIC) Number. In addition, amnesty aliens eligible for
restricted Medi-Cal benefits pursuant to section 50302(b)(3) must pos-
sess or have applied for an SSN and, if eligible, a HIC number.
(b) The SSN shall be provided at the time of application unless the
applicant must apply for the number. If application for an SSN must be
made, the number will be provided to the county department by the De-
partment or by the Social Security Administration.
(c) The HIC number shall be provided by the applicant or beneficiary
in accordance with section 50777.
(d) Medi-Cal shall not be denied, delayed or discontinued for an appli-
cant or beneficiary because of these requirements unless the applicant or
beneficiary refuses to cooperate.
(1) Ehgibility of an applicant or beneficiary who refuses to apply for
or provide a number shall be denied or discontinued.
(2) Eligibility of a child who is not applying on the child's own behalf
shall be denied or discontinued if a parent or caretaker relative living with
the child refuses to apply for or provide a number for the child.
(3) Persons ineligible for Medi-Cal in accordance with (1 ) or (2) shall
be ineligible members of the MFBU in accordance with section 50379.
(e) The county department shall assist the applicant or beneficiary by
explaining how to apply for an SSN orHIC number and by providing an
SSA Referral Notice, form MC 194.
(f) The county shall notify the beneficiary if the information provided
by that beneficiary does not result in verification of the SSN by SSA.
Medi-Cal eligibility shall be discontinued if the beneficiary fails, with-
out good cause, to respond to the notice within 60 days.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institufions
Code. Reference: Sections 14005.7 and 1401 1, Welfare and Institutions Code; and
Section 1320b(7)(a), Title 42, United States Code of Regulations.
History
1 . Amendment of subsection (d)(3) filed 12-15-77; effective thirtieth day thereaf-
ter (Register 77, No. 51).
2. Amendment filed 4-9-80; effective thirtieth day thereafter (Register 80, No.
15).
Page 336.4
Register 96, No. 36; 9-6-96
Title 22
Health Care Services
§ 50193
3. Amendment of subsection (d) (3) filed 1-8-8 1 ; effective thirtieth day thereafter
(Register 81, No. 2).
4. Amendment of subsection (a) filed 1 1-14-89 as an emergency pursuant to sec-
tion 9 of chapter 1441 of the Statutes of 1988; operative ll-14-89 (Register 89,
No. 48). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 3-14-90.
5. Amendment of subsection (a) refiled 3-8-90 as an emergency pursuant to sec-
tion 9 of chapter 1441 of the Statutes of 1 988; operative 3-13-90 (Register 90,
No. 12). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 7-11-90.
6. Certificate of Compliance as to 3-8-90 order transmitted to OAL 7-5-90 and
disapproved 8-6-90 (Register 90, No. 42).
7. Amendment of subsection (a) filed 8-23-90 as an emergency pursuant to sec-
tion 9 of chapter 1441 of the Statutes of 1988; operative 8-23-90 (Register 90,
No. 42). A Certificate of Compliance must be transmitted to OAL by 12-21-90
or emergency language will be repealed by operation of law on the following
day.
8. Certificate of Compliance as to 8-23-90 order transmitted to OAL 1 1-20-90
and filed 12-17-90 (Register 91, No. 5).
§ 50189. Redetermination — Frequency and Process.
(a) Persons or families determined to be eligible for Medi-Cal shall
have their eligibility redetermined at least once every 1 2 months.
(b) At the time of the redetermination, the beneficiary shall complete
a new Statement of Facts.
(c) The county department shall:
(1) Complete the redetermination within 12 months of the most recent
of the following:
(A) Approval of eligibility on any application, reapplication or resto-
ration which required a Statement of Facts form.
(B) Last redetermination.
(2) Inform beneficiaries in writing that income and eligibility informa-
tion, including tax information, will be obtained through the lEVS.
(3) Verify information on the Statement of Facts in accordance with
Section 50169 (d).
(4) Send a Notice of Action if there is a change in the beneficiary' s eli-
gibility status or share of cost.
(5) Provide an informational pamphlet on the CHDP program to the
beneficiary which describes the CHDP benefits available, and how and
where the benefits are provided in the county, if there are persons under
21 years of age in the family.
(d) A face-to-face interview shall be required at the time of redetermi-
nation for all MFBUs which contain at least one AFDC-MN or MI mem-
ber, except for MFBUs consisting of any of the following:
(1) Persons who receive Medi-Cal through the Aid for Adoption of
Children program.
(2) Persons who have a government representative, such as a public
guardian, acting on their behalf
(3) MI children who are not living with a parent or relative and for
whom a public agency is assuming financial responsibility in whole or
in part.
NOTE: Authority cited: Sections 10725, 10740 and 14124.5, Welfare and Institu-
tions Code. Reference: Sections 11004, 14001, 14005.4 and 14012, Welfare and
Institutions Code; and 42 Code of Federal Regulations 435.945(d).
History
1. Amendment of subsecfions (c) and (d) filed 12-15-77; effective thirtieth day
thereafter (Register 77, No. 51).
2. Amendment of subsection (c)(1)(A) filed 8-7-78; effective thirtieth day there-
after (Register 78, No. 32).
3. Amendment of subsection (d) filed 9-1-78; effecUve thirtieth day thereafter
(Register 78, No. 35).
4. Editorial cortection to History Note 3 (Register 78, No. 40).
5. Amendment of subsection (d)(3) filed 8-8-80; effective thirtieth day thereafter
(Register 80, No. 32).
6. Editorial correcfion of subsection (c)(1)(A) filed 7-7-83 (Register 83, No. 29).
7. Amendment of subsecfion (c) filed 7-16-87; operative 7-16-87 pursuant to
Government Code Section 11346.2(d) (Register 87, No. 30).
§ 501 91 . Status Reports.
(a) The county department shall require the completion of a Medi-Cal
Status Report form at three month intervals for all MFBU's which con-
tain at least one AFDC-MN or MI person. The requirement to complete
status reports shall not apply to the following:
(1) Persons who receive Medi-Cal through the Aid for Adoption of
Children program.
(2) Persons who have a government representative, such as a public
guardian, acting on their behalf
(3) MI children who are not hving with a parent or relative and for
whom a public agency is assuming financial responsibility in whole or
in part.
(4) Children who are requesting Medi-Cal in accordance with Section
50147.1.
(5) Persons who receive county General Assistance Benefits and
whose Medi-Cal eligibility factors are monitored at least quarterly by the
county Department under its general assistance program.
(6) MFBUs consisting solely of an eligible pregnant woman and/or in-
fant under one year of age.
(b) In addition to the status reports required in accordance with (a), the
county department, consistent with Article 2, may require persons or
families to complete status reports at more frequent intervals.
NOTE: Authority cited: Sections 10725, 14016. lOand 14124.5, Welfare and InsU-
tutions Code; Section 133.5, AB 251, Chapter 102, Statutes of 1981. Reference:
Sections 14005.4. 14005.9, 14010, 14011 and 14012, Welfare and Institufions
Code.
History
1. Amendment filed 9-1-78; effective thirtieth day thereafter (Register 78, No.
35).
2. Amendment of subsection (a)(3) filed 8-8-80; effective thirtieth day thereafter
(Register 80, No. 32).
3. Amendment of subsection (a) (4) filed 1-8-81 ; effecfive thirtieth day thereafter
(Register 81, No. 2).
4. Amendment of subsection (a) and new subsection (c) filed 11-30-81 as an
emergency; effective upon filing (Register 81, No. 49). A Certificate of Com-
pliance must be transmitted to OAL within 120 days or emergency language
will be repealed on 3-30-82.
5. Certificate of Compliance filed 3-30-82 (Register 82, No. 14).
6. Amendment of subsection (a) and repealer of subsection (c) filed 10-1-82 as
an emergency; effective upon filing (Register 82, No. 40). A Certificate of Com-
pliance must be transmitted to OAL within 120 days or emergency language
will be repealed on 1-29-83.
7. Certificate of CompUance transmitted to OAL 12-30-82 and filed 2-2-83
(Register 83, No. 6).
8. Editorial correction of subsection (a) filed 7-7-83 (Register 83, No. 29).
9. Editorial correction of printing error in subsecfion (a) (Register 93, No. 35).
10. New subsecfion (a)(6) and amendment of Note filed 4-27-94 as an emergen-
cy; operative 4-27-94 (Register 94, No. 17). A Certificate of Compliance must
be transmitted to OAL by 8-25-94 or emergency language will be repealed by
operafion of law on the following day.
1 1 . Certificate of Compliance as to 4-27-94 order transmitted to OAL 8-24-94
and filed 9-29-94 (Register 94, No. 39).
12. Editorial cortecnon of Note (Register 94, No. 39).
§ 50192. Testing Techniques for Redeterminations, Status
Reporting and Verification.
(a) Notwithstanding Sections 50169, 50189 and 50191, the Director
may, in counties selected by the Director, establish requirements for re-
determinations, status reporting, and verification of information on the
Statement of Facts for the purpose of testing the effectiveness of the dif-
ferent administrative requirements.
(b) Selection criteria may include, but shall not be limited to:
(1) Caseload size.
(2) Past county adininistrative requirements.
(3) Population characteristics.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Secfions 1 0600, 1 1 004, 1 1 050, 14001, 14005.4, 14005.7, 1401 1
and 14012, Welfare and Insfitutions Code.
History
1. New secfion filed 9-1-78; effective thirtieth day thereafter (Register 78, No.
35).
2. Editorial correcfion of NOTE filed 7-7-83 (Register 83, No. 29).
§ 50193. Beginning Date of Eligibility.
(a) The beginning date of eligibility for Medi-Cal for persons who ap-
ply under any public assistance program shall be the first day of the
month of application, providing the person meets the citizenship, resi-
dency, hnkage and financial ehgibility criteria of the appropriate pro-
gram, notwithstanding the beginning date of the cash grant. For persons
Page 336.5
Register 2000, No. 38; 9-22-2000
§ 50195
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
who do not meet these eligibility criteria during the month of apphcation,
the beginning date of eligibility shall be the first day of the first month
in which the above specified eligibility criteria of the appropriate pro-
gram are met.
(b) The beginning date of eligibility for Medi-Cal specified in (a) shall
also apply to:
(1) Persons who apply for AFDC and meet eligibility criteria in the
month of application but whose eligibility is denied because they no
longer meet eligibility criteria at the time eligibility for AFDC is deter-
mined.
(2) Persons who apply for SSI/SSP and meet the eligibility criteria but
are denied because they die before the application can be processed and
an application is filed on their behalf at the county department within 30
days of receipt of a written notice of denial.
(c) The beginning date of eligibility for persons applying only for
Medi-Cal shall be: thefirstday of the month of application, if all eligibil-
ity criteria of the appropriate Medi-Cal program are met. If the eligibility
criteria are not met during the month of application, the beginning date
of eligibility shall be the first day of the month, subsequent to the month
of application, during which the eligibility criteria of the appropriate
Medi-Cal program are met.
(d) For the purposes of (c), eligibility criteria are considered to be met
throughout the month if they are met at any time during the month, except
for persons specified in Section 50273(a).
Note-. Authority cited: Sections 10723 and 14124.5, Welfare and Institutions
Code. Reference; Sections 11014, 11016, 14005, 14018 and J4053, Welfare and
Institutions Code.
History
1. Change without regulatory effect renumbering former section 50701 to new
section 501 93 filed 9-19-2000 pursuant to section 1 00, title 1 , California Code
of Regulations (Register 2000, No. 38).
§50195. Period of Eligibility.
(a) The period of eligibility for Medi-Cal for persons eligible for
AFDC or SSI/SSP shall begin with the date specified in Section 50701
(a) and (b), and shall continue through each successive month during
which the person is determined to be eligible.
(b) The period of eligibility for Medi-Cal for persons eligible as Other
PA recipients shall begin with the date specified in Section 50701 (c), and
shall continue through each successive month during which the person
meets all eligibility requirements of the appropriate Other PA category.
(c) The period of eligibility for Medi-Cal for persons eligible as MN
or MI, except as specified in (d), shall begin with the date specified in
Section 50701 (c), and shall continue through each successive month
during which the beneficiary meets the appropriate basic program re-
quirements in Article 5 of this chapter and all of the following conditions:
(1) Has cooperated with the county department to the extent required
by Sections 50185 and 50187.
(2) Has met the property requirements specified in Article 9 at some
time during the month.
(3) Has met the citizenship, residence and institutional status require-
ments specified in Articles 6 and 7 at some time during the month.
(d) The period of eligibility for Medi-Cal for a child applying on his
or her own behalf in accordance with Section 50147. 1 (a) shall begin with
the date specified in Section 50701 (c), and shall continue through each
successive month during which the child meets both of the following
conditions:
(1) Has met the conditions specified in (c).
(2) Has submitted a completed and signed form MC 4026 to the county
department during the month in question which states that the child has
a need for services related to sexual assault, daig or alcohol abuse, preg-
nancy, family planning or venereal disease.
(e) The period of eligibility shall be modified for any portion of a
month in which a person is ineligible due to institutional status, as de-
scribed in Section 50273.
(f) A final date of eligibility shall be established when the county de-
partment determines that the person or family will no longer meet all eh-
gibility requirements as of the first of the following month. The final date
shall be the last day of the:
(1) Current month, if the discontinuance is not an adverse action as de-
fined in Section 50015.
(2) Current month, if the discontinuance is an adverse action and the
10-day advance notice requirements of Section 50179(e) will be met in
the current month.
(3) Following month, if the discontinuance is an adverse action and the
10-day advance notice requirements will not be met in the current month.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 11014, 11016 and 14053, Welfaie and Institutions
Code.
History
1. Change without regulatory effect renumbering former section 50703 to new
section 50195 filed 9-1 9-2000 pursuant to section 100, title 1 , California Code
of Regulations (Register 2000, No. 38).
§ 50197. Retroactive Eligibility.
(a) In addition to the period of eligibility specified in Section 50703,
an applicant shall be eligible for Medi-Cal in any of the three months im-
mediately preceding the month of application orreapplication if all of the
following requirements are met in that month:
(1) The county department determines that the applicant would have
been eligible for one of the programs specified in Section 50201, except
as specified in (c), had an application been made.
(2) The applicant received heath services.
(3) The applicant was not previously denied Medi-Cal for the month
in question, unless the application was denied for one of the following
reasons:
(A) County error.
(B) The applicant' s failure to cooperate, when that failure, or the appli-
cant' s subsequent failure to reapply, was due to circumstances beyond
the control of the applicant.
(b) The request for retroactive eligibility shall be made in accordance
with Section 50148 and shall be treated as any other application, except
that persons applying on the basis of disability shall have their disability
determined prior to determining retroactive eligibility.
(c) A person 21 years of age or older shall not be retroactively eligible
as a medically indigent person unless either of the following conditions
exist.
(1) The person was residing in a skilled nursing or intermediate care
facility during any part of both:
(A) The month of application.
(B) The month for which retroactive eligibility is requested.
(2) The person is a woman with a confirmed pregnancy.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4, 14019, 14019.6, 14142 arid 14145, Welfare
and Institutions Code.
History
1. Change without regulatory effect renumbering former section 50710 to new
section 50197 filed 9-19-2000 pursuant to section 100, title 1, California Code
of Regulations (Register 2000, No. 38).
§ 50199. Certification for Medi-Cal— Completion.
(a) A person or family determined to be eligible for Medi-Cal shall not
receive a Medi-Cal card until certified for Medi-Cal.
(b) Certification for Medi-Cal shall be completed by:
(1) The county department for:
(A) Persons who have no share of cost or who have a share of cost for
long-term care which is less than the cost of care.
(B) Persons who have a share of cost, other than those specified in (A),
and who complete form MC 1 1 3, in accordance with Section 50658 (d).
(2) The Department for persons who have a share of cost, other than
those specified in (1)(A) and (B).
Page 336.6
Register 2000, No. 38; 9-22-2000
Title 22
Health Care Services
§ 50203
History
1. Change without regulatory effect renumbering former section 50715 to new
section 50199 filed 9-19-2000 pursuant to section 100, title 1, California Code
of Regulations (Register 2000, No. 38).
Article 5. Medi-Cal Programs
§ 50201. Medi-Cal Programs— General.
(a) A person or family may be eligible for Medi-Cal under one of the
following programs.
(1) Aid to Families with Dependent Children (AFDC).
(2) Supplemental Security Income/State Supplemental Program (SSI/
SSP).
(3) Other Public Assistance (Other PA).
(4) Medically Needy (MN).
(5) Medically Indigent (MI).
(6) Miscellaneous Special Programs.
(7) Medi-Cal Special Treatment Programs.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14142 and 14145, Welfare and Institutions Code.
History
1. Amendment filed 8-7-78; effective thirtieth day thereafter (Register 78, No.
32).
2. Ameridment filed 7-31-81 as an emergency; effecfive upon filing (Register 81 ,
No. 33). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 1 1-28-81.
3. Certificate of Compliance transjnitted to OAL 11-6-81 and filed 1-27-82
(Register 82, No. 5).
4. Amendment filed 7-19-82; effective thirtieth day thereafter (Register 82, No.
30).
§ 50203. Medically Needy Program.
(a) A person's eligibility shall be determined under the Medically
Needy program if that person is any of the following:
(1) An aged, Wind or disabled person who meets one of the following
conditions:
(A) Is not eligible for or does not want to receive assistance as a PA
or Other PA recipient.
(B) Has an application pending for SSI/SSP.
(2) A child or family member who is both:
(A) Linked to AFDC in accordance with Section 50205.
(B) Not ehgible for or does not want to receive assistance as a PA or
Other PA recipient.
[The next page is 337.]
Page 336.7
Register 2000, No. 38; 9-22-2000
Title 22
Health Care Services
§ 50213
•
(3) A caretaker relative who chooses to be included in a child's MFBU
in accordance with Section 50373 (a)(5) (A) 13 or when all children are
PA or other PA.
(b) A person who meets the conditions of more than one of the follow-
ing categories shall have eligibility determined on the basis of the catego-
ry listed first unless the person requests otherwise:
(1) Blindness, as defined in Section 50219.
(2) Age, as defined in Section 50221.
(3) Disability, as defined in Section 50223.
(4) Linkage to AFDC, as defined in Section 50205.
(c) In order to be eligible under this program the persons listed in (a)
shall meet the property, citizenship, residence, institutional status and
cooperation requirements specified in these regulations.
(d) In order to be certified and receive a Medi-Cal card under this pro-
gram, the persons listed in (a) shall be determined eligible and meet the
income and share-of-cost requirements specified in these regulations.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14005.3 and 14005.7, Welfaie and Institutions Code.
HtSTORY
1 . Repealer and new section filed 3-7-80 as an emergency; effective upon filing
(Register 80, No. 9). A Certificate of Compliance must be transmitted to OAL
within 120 days or emergency language will be repealed on 7-6-80.
2. Certificate of Compliance filed 6-6-80 (Register 80, No. 23).
3. Amendment of subsection (a) filed 2-11-82; effective thirtieth day thereafter
(Register 82, No. 7).
4. Change without regulatory effect of subsection (a)(3) (Register 87, No. 11).
5. Amendment of subsecfion (a) and repealer of subsection (e) filed 4-17-89; op-
erative 5-17-89 (Register 89, No. 48).
§ 50205. Linkage to AFDC.
(a) Linkage to AFDC exists if a child is living with a relative and de-
prived of parental support or care. Deprivation shall be established if all
conditions of any one of the following sections are met at any time during
the month:
(1) Deprivation — Deceased Parent, section 50209.
(2) Deprivation — Physical or Mental Incapacity of Parent, Section
50211.
(3) Deprivation — Absent Parent, Section 50213.
(4) Deprivation — Unemployed Parent, Section 50215.
(b) A child who is deprived of parental support or care for more than
one reason, may have linkage to AFDC established on any basis of depri-
vation that is listed in (a). The advantages and disadvantages of each basis
shall be explained to the applicant or beneficiary and the basis of depriva-
tion shall be the choice of the child's parent or caretaker relative.
(c) All family members living in the home, except those children ex-
cluded from the MFBU in accordance with Section 50381 and children
who are ineligible for Medi-Cal, shall be considered in determining
whether linkage to AFDC exists. Family members also include persons
who are PA or other PA recipients.
Note-. Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4, 14005.7, 14051 and 14052, Welfare and Insti-
tutions Code.
History
1 . Amendment filed 3-7-80; effecU ve thirtieth day thereafter (Register 80, No. 9).
2. New subsecfion (d) filed 1-8-81 ; effecfive thirtieth day thereafter (Register 81,
No. 2).
3. Amendment filed 3-24-82; effective thirtieth day thereafter (Register 82, No.
13).
4. Amendment of subsections (b) and (c) filed 6-3-87; operative 7-3-87 (Register
87, No. 24).
§ 50207. Deprivation — Relinquishment for Adoption.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Insfitutions
Code. Reference: Sections 14005.4, 14005.7, 14051 and 14052, Welfare and Insfi-
tutions Code.
History
1. Repealer filed 3-24-82; effective thirtieth day thereafter (Register 82, No. 13).
§ 50209. Deprivation — Deceased Parent.
(a) Deprivation of parental support or care exists if either of the child's
parents is deceased.
(b) Children of a deceased parent and the remaining parent living with
the child shall be linked to AFDC on the basis of this deprivation factor.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14001.1 and 14005.7, Welfare and Institutions Code.
History
1. Editorial conection adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 5021 1 . Deprivation — Physical or Mental Incapacity of a
Parent.
(a) Deprivation of parental support or care exists if either of the child's
parents is physically or mentally incapacitated.
(b) A parent is incapacitated if such parent has a physical or mental il-
lness, defect or impairment that is expected to last at least 30 days, is veri-
fiable in accordance with Section 50167, and does either of the follow-
ing:
(1) Reduces substantially or eliminates the parent's ability to support
or care for the child.
(2) Causes one of the following situations:
(A) The parent is prevented from working full-time at a job in which
customarily engaged, and from working full-time on another job for
which equipped by education, training or experience or which could be
learned by on-the-job training.
(B) Employers refuse to employ the parent for work the parent could
do and is willing to do, because of behavioral or other disorders which
interfere with the securing and maintaining of employment.
(C) The parent is prevented from accomplishing as much on a job as
a regular employee and, as a result, is paid on a reduced basis.
(D) The parent is blind or disabled in accordance with Section
50223(a)(1) or (b).
(E) The parent has qualified for and is employed in a job which is reha-
bilitative or therapeutic or is in a sheltered workshop, and which is not
considered to be full-time.
(c) The following persons shall be linked to AFDC on the basis of this
deprivarion factor:
(1) The children of an incapacitated parent.
(2) The incapacitated parent.
(3) The spouse of the incapacitated parent or the second parent of the
children whose basis of deprivation is an incapacitated parent.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.3, 14005.7 and 14051, Welfare and Institutions
Code.
History
1. Amendment of subsection (b)(2)(D) filed 3-7-80 as an emergency; effective
upon filing (Register 80, No. 9). A Certificate of Compliance must be trans-
mitted to OAH within 120 days or emergency language will be repealed on
7-6-80.
2. Certificate of Compliance filed 6-6-80 (Register 80, No. 23).
3. Amendment of subsection (b)(2)(A) filed 8-8-80; effective thirtieth day there-
after (Register 80, No. 32).
4. Amendment of subsection (c) filed 1-8-81; effective thirtieth day thereafter
(Register 81, No. 2).
5. Amendment of subsection (b) filed 1 1-20-96; operative 12-20-96 (Register
96, No. 47).
§ 50213. Deprivation — Absent Parent.
(a) Deprivation of parental support or care exists if there is continued
absence of one or both of a child's parents from the home.
(b) Deprivation does not exist when one or both of the parents is absent
from the home on a temporary basis, such as for a:
(1) Visit.
(2) Trip.
(3) Temporary assignment undertaken in connection with current or
prospective employment.
(4) Parental absence due solely to active duty in the uniformed services
of the United States. Uniformed services means the Army, Navy, Air
Force, Marine Corps, Coast Guard, National Oceanographic and Atmo-
spheric Administration and Public Health Service of the United States.
Page 337
Register 96, No. 47; 11-22-96
§ 50215
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
(c) Continued absence shall be considered to exist wiien a parent is
physically absent from the home and both otthe following conditions ex-
ist:
(1 ) The nature of the absence results in an interruption or termination
of the parent's functioning as a provider of maintenance, physical care,
or guidance for the child, regardless of the reason for the absence or the
length of time the parent has been absent.
(2) The known or indefinite duration of the absence precludes count-
ing on the parent's performance of the function of planning for the pres-
ent support or care of the children.
(d) When the conditions specified in (c) exist, regular or frequent visits
with the child by a parent who is physically absent from the home shall
not in and of itself prevent a determination that "continued absence" ex-
ists. "Continued absence" shall be considered to exist when the child
lives with each parent for alternating periods of time.
(e) If the parent in the home has stated on the Statement of Facts that
the other parent has left the family, this shall be considered to mean that
there is continued absence unless the county department has conflicting
information. In the case of conflicting information, the written statement
shall be supported by at least one of the following:
(1) Written statements of the absent parent or other persons with prior
knowledge of the family relationship.
(2) The actions of the applicant or beneficiary or the absent parent
clearly indicate:
(A) Physical absence of the other parent.
(B) Interruption of or marked reduction in marital and family responsi-
bilities.
(3) Other evidence that substantiates continued absence.
(f) Absence of a parent on active duty in the Armed Forces may or may
not constitute deprivation, dependent upon whether or not the facts in the
individual case indicate an interruption of, or marked reduction in, mari-
tal and family responsibilities. The county department shall determine if
deprivation exists by examining each case individually in light of all rele-
vant factors, including:
(1) Length of absence.
(2) Assignment to a duty station to which the family may not move.
(3) The financial impact on the family, if the parent may be accompa-
nied to that station.
(4) The extent of family disruption that would be caused if family
members would have to give up employment to accompany the parent to
the assigned duty station.
(g) Children of an absent parent, and the parent in the home, shall be
linked to AFDC on the basis of this deprivation factor. If the parent in the
home is married, and the spouse also has children from a prior union, the
following persons shall be linked to AFDC:
(1) The children of each parent, other than mutual children.
(2) Both parents.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4, 14005.7 and 14051, Welfare and Institutions
Code.
History
1 . Amendment of subsection (f)(2) filed 10-24-86; effective thirtieth day thereaf-
ter (Register 86, No. 43).
2. Amendment of subsection (b), repealer of subsection (e) and relettering of sub-
section (f) to subsection (e) filed 7-9-87; operative 8-8-87 (Register 87, No.
30).
3. Amendment of subsections (c)-(f) filed 4-17-89; operative 5-17-89 (Register
89, No. 48).
§ 50215. Deprivation — Unemployed Parent.
(a) Deprivation of parental support or care exists if a parent with whom
the the child lives is any of the following as limited by (b), (c) and (d):
(1) Not working.
(2) Working less than 100 hours a month.
(3) Employed on an intermittent basis more than 100 hours per month
and the hours in excess of 100 hours are of a temporary nature. Tempo-
rary nature is shown if the parent was under the 100 hour standard for the
two prior calendar months and is expected to be under the standard during
the next month.
(4) Unemployed and has been accepted for or is participating in an
education or training program essential to future self-support which is all
of the following:
(A) Directed toward a specific occupation and will qualify the unem-
ployed person for an occupation in demand in the local area.
(B) A program which will be completed by the unemployed person
within a maximum of two years.
(C) Not a program which involves post baccalaureate work.
(b) For deprivation due to unemployment to exist, the unemployed
parent must meet all of the following conditions:
(1) Is the principal wage earner as determined in accordance with (c).
(2) Has not been employed, or has worked less than 100 hours, in the
last 30 days.
(3) Is available for and actively seeking employment.
(4) Has not, without good cause, within the last 30 days either:
(A) Quit a job or employment related training.
(B) Refused a bona fide offer of employment or employment related
training.
(5) Possesses, or has applied for, a Social Security number.
(6) Has not refused to apply for and accept any unemployment insur-
ance benefits (UIB) to which he is entitled.
(7) Has established a connection with the labor force in either of the
following ways:
(A) By meeting one of the following requirements in 6 calendar quar-
ters within any 1 3 calendar quarter period ending within the year prior
to the month of application for Medi-Cal:
1 . Earns a gross income of at least $50 during the quarter.
2. Participated for at least five days during the quarter in any activity
administered under any of the following:
a. The Work Incentive (WIN) program.
b. The Work Incentive Demonstration Program (WIN Demo).
c. The Community Work Experience Program (CWEP).
d. The Greater Avenues for Independence (GAIN) Program.
3. A combination of 1. and 2.
(B) By having received, or having been eligible to receive, UIB within
the year prior to the month of application. A person is eligible to receive
UIB if either of the following conditions is met:
1. The person would have been eligible to receive unemployment
compensation upon filing an application.
2. The person performed work not covered by Unemployment Com-
pensation Law, and the coverage of such work, if combined with any cov-
ered work, would create eligibility to receive unemployment compensa-
tion upon filing an application.
(8) Is not unemployed throughout the month as a result of participation
in a labor dispute.
(c) The principal wage earner is the parent who has earned the greater
amount of income in the 24 month period immediately preceding either
of the following:
(1) The month of application, reapplication or restoration.
(2) The date of a redetermination that a family's circumstances have
changed in such a way as to meet the requirements for deprivation due
to the unemployment of a parent.
(d) The following persons shall be linked to AFDC on the basis of this
deprivation factor:
(1) The children of the unemployed parent.
(2) The unemployed parent.
(3) The second parent of the children whose basis of deprivation is un-
employed parent.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4, 14005.7 and 14051, Welfare and Institutions
Code.
History
1 . Amendment of subsections (a)(4) and (f) filed 12-1 5-77 ; effective thirtieth day
thereafter (Register 77, No. 51).
2. Amendment filed 1-8-8 1 ; effective thirtieth day thereafter (Register 81, No. 2).
Page 338
Register 96, No. 47; 11-22-96
Title 22
Health Care Services
§ 50227
•
3. Amendment filed 4-2-82 as an emergency; effective upon filing (Register 82,
No. 14). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 7-31-82.
4. Certificate of Compliance transmitted to OAL within 120 days and filed
8-10-82 (Register 82. No. 33).
5. Repealer of subsection (b) (8) and relettering of subsection (b) (9) to subsection
(b)(8) filed 12-8-83; effective thirtieth day thereafter (Register 83, No. 50).
6. Amendment of subsection (b) (7) (A) filed 10-24-86; effective thirtieth day
thereafter (Register 86, No. 43).
7. Amendment of subsection (c) filed 4-17-89; operative 5-17-89 (Register 89,
No. 48).
8. Editorial conection of printing error in subsections (d)(2) and (d)(3) (Register
93, No. 13).
§ 50216. Good Cause — Refusal of Employment.
(a) Good cause for refusal of employment or training or for quitting a
job or training as required in Section 50215 (b), shall be found if the appli-
cant or beneficiary refuses or quits for any of the following reasons:
(1) The offer of employment was from an employer who did not:
(A) Possess an appropriate license to engage in business.
(B) Withhold or hold in trust the employee contributions required by
Part 2 of Division 1 of the Unemployment Insurance Code, Section 2601
et seq., for unemployment compensation disability benefits and does not
transmit all such employee contributions to the Department of Social Ser-
vices as required by Section 986 of the Unemployment Insurance Code.
(C) Carry either workers' compensation insurance or possess a certifi-
cate of self-insurance as required by Division 4 of the Labor Code, Sec-
tion 3201 et seq.
(2) The employment or training violated applicable health and safety
laws and regulations.
(3) The wage offered for the employment or training was less than the
applicable state or federal minimum wage or was lower than the custom-
ary wage in the community for that particular employment or training as
set by the Employment Development Department, whichever is higher.
(4) The acceptance of employment would preclude completion of a
job training or educational program approved by the state or county.
(5) The employment or training was in excess of the individual's men-
tal or physical capacity.
(6) The individual was ill or required to care for an ill member of the
immediate family and no other care arrangements were feasible.
(7) Child care arrangements could not be made.
(8) The individual was without a means of getting to or from the place
of employment or training.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.7 and 14051, Welfare and Institutions Code.
History
1 . Amendment filed 12-15-77; effective thirtieth day thereafter (Register 77, No.
51).
2. Repealer of subsection (a)(5) and consecutive renumbering of subsections
(a)(6)-(a)(9) to subsections (a)(5)-(a)(8) filed 4-2-82 as an emergency; effec-
tive upon filing (Register 82, No. 14). A Certificate of Compliance must be
transmitted to OAL within 120 days or emergency language will be repealed on
7-31-82.
3. Certificate of Compliance transmitted to OAL within 120 days and filed
8-10-82 (Register 82, No. 33).
4. Editorial correction of subsections (a) and (a)(1)(B) filed 7-7-83 (Register 83,
No. 29).
§ 50216.5. Linkage to AFDC — Placement in Foster Care.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4, 14005.7, 14051, and 14052, Welfare and In-
stitutions Code.
History
1 . New section filed 3-7-80; effective thirtieth day thereafter (Register 80, No. 9).
2. Amendment of subsection (a) filed 1-8-81; effective thirtieth day thereafter
(Register 81, No. 2).
3. Repealer filed 3-24-82; effective thirtieth day thereafter (Register 82, No. 13).
§ 5021 7. Linkage to SSI/SSP.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14005.3, Welfare and Institutions Code.
History
1 . Repealer filed 3-7-80 as an emergency; effective upon filing (Register 80, No.
9). A Certificate of Compliance must be transmitted to OAH within 120 days
or emergency language will be repealed on 7-6-80.
2. Certificate of Compliance filed 6-6-80 (Register 80, No. 23).
§50219. Blindness.
(a) Persons shall be considered to be blind if there has been a medical
determination that they have either of the following conditions:
(1) Central visual acuity of no more than 20/200 with correction.
(2) Tunnel vision, which is a limited visual field of 20 degrees or less.
§50221. Age.
(a) Persons are aged if they are 65 years of age or older. Persons are
considered to be 65 years of age on the first day of the month in which
they reach age 65.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.3, 14005.7 and 14050.1, Welfare and Institu-
tions Code.
History
1 . Editorial cortection adding NOTE filed 7-7-83 (Register 83, No. 29).
§ 50223. Disability.
(a) Persons 1 8 years of age or over are disabled if they meet the defini-
tion in (1) or the definition in (2):
(1) Federally disabled persons are persons who meet the definition of
disability in Title II or Title XVI, Social Security Act.
(2) SGA-disabled persons are persons who were once determined to
be disabled in accordance with the provisions of the SSI/SSP program
(Section 1614, Part A, Title XVI, Social Security Act) and meet both the
following conditions:
(A) Were eligible for SSI/SSP but became ineligible because of en-
gagement in substantial gainful activity as defined in Title XVI regula-
tions.
(B) Continue to suffer from the physical or mental impairment which
was the basis of the disability determination.
(b) Children who are under 18 years of age shall be considered to be
disabled if they have any medically determinable physical or mental im-
pairment of comparable severity to that which would make an adult dis-
abled in accordance with (a)(1) or (2).
(c) Eligibility or share of cost determinations effective on or after Jan-
uary 1 , 1980 shall be based on the provisions of this Section.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14005.3, Welfare and Institutions Code.
History
1. Amendment filed 3-7-80 as an emergency; effecfive upon filing (Register 80,
No. 9). A Certificate of Compliance must be transmitted to OAH within 120
days or emergency language will be repealed on 7-6-80.
2. Certificate of Compliance filed 6-6-80 (Register 80, No. 23).
3. Amendment of subsection (a)(1) filed 7-2-80 effective thirtieth day thereafter
(Register 80, No. 27).
§ 50227. Public Assistance Cash Grant Programs.
(a) Public assistance cash grant programs include the following pro-
grams:
(l)AFDC.
(2) SSI/SSP.
(3) Cuban Refugee Cash Grant.
(4) Indochinese Refugee Cash Grant.
(5) Emergency Assistance (EA).
(b) Except as provided in (d) and (e) below, persons receiving a cash
grant under any one of the programs specified in (a) shall automatically
receive a Medi-Cal card for each month in which they receive the cash
grant.
(c) Except as provided in (d) and (e) below, persons not currently in
receipt of a cash grant under one of the programs specified in (a), shall
automatically receive a Medi-Cal card for each month in which they are
ineligible for the cash grant because of either of the following reasons:
(1) Their cash grant has been suspended for an administradve reason
such as to:
(A) Determine the amount of the cash grant.
Page 339
Register 94, No. 39; 9-30-94
§ 50237
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
(B) Adjust an overpayment.
(C) Change the recipient's representative payee.
(2) They are in the Zero Basic Grant category because the net income
of the family exceeds the AFDC payment standard but does not exceed
the Minimum Basic Standard of Adequate Care (MBSAC).
(d) Persons who (1) fail to assign to the state their rights or the rights
of individuals for whom they can legally assign rights to medical support
and/or (2) fail to cooperate, without good cause, in identifying and pro-
viding information regarding any other coverage or any third party who
is or may be liable to pay for medical coverage, care, services, or support
payments (including individuals required to cooperate in the establish-
ment of paternity) shall be ineligible for Medi-Cal.
(e) Persons shall not be considered Public Assistance recipients for
purposes of Medi-Cal ehgibility when the following conditions exist.
The person is both:
(1) Age 21 years or older.
(2) Receiving AFDC for which federal financial participation is not
obtainable or EA as part of an unemployed parent family.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; and Section 87, Chapter 1594, Statutes of 1982, SB 2012. Reference: Sec-
tions 1 1250.5, 1 1406.5, 14005.1 and 14008.6, Welfare and Institutions Code; and
42 C.F.R. Sections 433.135, 433.136. 433.137, 433.138, 433.145, 433.146,
433.147, 433.148 and 435.604.
History
1. Amendment of subsection (a) filed 8-7-78; effective thirtieth day thereafter
(Register 78, No. 32).
2. Amendment of subsection (a) filed 7-31-81 as an emergency; effective thirtieth
day thereafter (Register 81, No. 33). A Certificate of Compliance must be trans-
mitted to OAL within 120 days or emergency language will be repealed on
11-28-81.
3. Certificate of Compliance transmitted to OAL 11-6-81 and filed 1-27-82
(Register 82, No. 5).
4. Amendment of subsections (a) and (b) and new subsecfion (d) filed 12-31-82
as an emergency; effective upon filing (Register 83, No. 2). A Certificate of
Compliance must be transmitted to OAL within 120 days or emergency lan-
guage will be repealed on 4-30-83.
5. Certificate of Compliance transmitted to OAL 4-13-83 and filed 5-16-83
(Register83, No. 21).
6. Editorial correction of Note filed 5-16-83 (Register 83, No. 21).
7. Amendment of subsections (b) and (c) and Note, new subsecfion (d) and sub-
secfion relettering filed 4-16-93 as an emergency; operative 4-16-93 (Register
93, No. 1 6). A Certificate of Compliance must be transmitted to OAL 8-16-93
or emergency language will be repealed by operation of law on the following
day.
8. Certificate of Compliance as to 4-16-93 order including amendment of Note
transmitted to OAL 8-13-93 and filed 9-23-93 (Register 93, No. 39).
§ 50237. Other Public Assistance Program.
(a) The Other Public Assistance Program consists of categories of
Medi-Cal beneficiaries defined in Sections 50243 through 50247. Ex-
cept as specified in Sections 50243 through 50247, individuals applying
for Medi-Cal under any of the Other Public Assistance Program catego-
ries shall meet all of the requirements of AFDC or SSI/SSP.
NOTE; Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.1, 14005.7, and 14050.1, Welfare and Institu-
tions Code.
History
1. Amendment filed 8-7-78; effective thirtieth day thereafter (Register 78, No.
32).
2. Amendment filed 7-31-81 as an emergency; effecUve upon filing (Register 81,
No. 33). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 1 1-28-81.
3. Certificate of Compliance transmitted to OAL 11-6-81 and filed 1-27-82
(Register 82, No. 5).
4. Amendment filed 4-2-82 as an emergency; effective upon filing (Register 82,
No. 14). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 7-31-82.
5. Certificate of Compliance transmitted to OAL within 120 days and filed
8-10-82 (Register 82, No. 33).
§ 50241 . Children Not in School or Training.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and InsUtutions
Code. Reference: Sections 14005.1, 14005.7 and 14050.1, Welfare and Institu-
tions Code.
History
1 . Repealer filed 4-2-82 as an emergency; effective upon filing (Register 82, No.
14). A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on 7-31-82.
§ 50243. Four Month Continuing Eligibility.
(a) The Four Month Continuing category includes persons who were:
(1) Discontinued from AFDC due solely to increased earnings from
employment or increased hours of einployment of a child in or added to
the AFDC unit or a parent of a child or added to the filing unit, and were
meinbers of a family receiving an AFDC cash grant or eligible under Sec-
tion 50227 (c)(1) in at least three of the six months immediately prior to
the month they became ineligible for AFDC.
This Four Month Continuing category does not include persons who
were discontinued from AFDC due to any of the following:
(A) A stepparent contribution.
(B) An increase in a stepparent contribution.
(C) The return of an absent parent to the home which ends deprivation.
(D) The stepparent's abihty to meet the needs of the parent.
(E) The expiration of the $30 plus 1/3 or $30 earned income disregard.
(2) Discontinued from AFDC due (wholly or in part) to the collection
or increased collection of child/spousal support, beginning August 1,
1984 and ending September 30, 1988 providing such persons were re-
ceiving an AFDC cash under Section 50227 (c)(1) in at least three of the
six months prior to the month they became ineligible for AFDC.
(b) Eligibility for Four Month Continuing based on increased earnings
or hours of employment shall continue for a period of four months fol-
lowing the most recent month in which the family became ineligible for
AFDC, providing that the family maintains California residency and a
family member continues to be employed.
(c) Eligibility for Four Month Continuing based (wholly or in part) on
the collection or increased collection of child/spousal support shall con-
tinue for a period of four months following the most recent month in
which the family became ineligible for AFDC.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and InsUtutions
Code. Reference: Sections 14005.1 and 14050.1, Welfare and InsUtutions Code.
History
1 . Amendment filed 3-7-80; effective thirtieth day thereafter (Register 80, No. 9).
2. Amendment of subsection (a)(1), (b) - (d) filed 4-15-85 as an emergency; ef-
fective upon filing (Register 85, No. 16). A Certificate of Compliance must be
transmitted to OAL within 1 20 days or emergency language will be repealed on
8-13-85.
3. Certificate of Compliance including amendment transmitted to OAL 8-13-85
and filed 9-18-85 (Register 85, No. 38).
4. Amendment filed 9-11-87; operative 10-1 1-87 (Register 87, No. 37).
5. Amendment of subsection (b) filed 4-17-89; operafive 5-17-89 (Register 89,
No. 48).
6. Certificate of Compliance filed 9-12-79 (Register 79, No. 37).
§ 50244. Nine Month Continuing Eligibility.
(a) The Nine Month Continuing category includes persons who were
discontinued from AFDC due solely to the expiration of the $30 plus 1/3
or $30 earned income disregard specified under that program.
(b) Eligibility under this category shall continue for a period of nine
consecutive months following the most recent month in which the fanuly
became ineligible for AFDC, regardless of whether the other conditions
of eligibility are met.
(c) The provisions of this regulation also apply to eligibility determi-
nations or redeterminations made retroactively to October 1, 1984.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and InsUtutions
Code; Section 14, AB 1557, Chapter 1447, Statutes of 1984. ELeference: Section
14005.8, Welfare and Institutions Code.
History
1. New section filed 4-15-85 as an emergency; effective upon filing (Register 85,
No. 16). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 8-13-85.
Page 340
Register 94, No. 39; 9-30-94
Title 22
Health Care Services
§ 50251
•
•
2. Certificate of Compliance including amendment of subsection (a) transmitted
to OAL 8-13-85 and filed 9-18-85 (Register 85, No. 38).
§ 50245. In-Home Supportive Services (IHSS).
(a) A person shall be eligible under the In-Home Supportive Services
({HSS) category if the person is receiving IHSS as defined in the social
services regulations of the Department of Social Services and all of the
requirements in either (1) or (2) are met:
(1) The person:
(A) Is eligible for SSI/SSP but does not wish to apply or would be eligi-
ble for SSI/SSP except that the person's income is in excess of the SSI/
SSP payment level.
(B) Is paying all of his or her net non-exempt income in excess of the
SSI/SSP payment level toward the cost of IHSS.
(2) The person:
(A) Was once determined to be disabled in accordance with Section
1614, Part A, Title XVI, Social Security Act.
(B) Was eligible for SSI/SSP but became ineligible because of engage-
ment in substantial gainful activity as defined in Title XVI regulations.
(C) Continues to suffer from the physical or mental impairments
which were the basis of the disability determination.
(D) Has been determined by the county social services staff to require
assistance in one or more of the areas specified under the definition of
severely impaired in the social services regulations of the Department of
Social Services.
(E) Is paying all of his or her net non-exempt income in excess of the
SSI/SSP payment level toward the cost of IHSS.
(b) The provisions of this regulation shall also apply to eligibility de-
terminations or redeterminations made retroactively to January 1, 1979.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Insfitutions
Code. Reference: Sections 12305, 12305.5, Welfare and Institutions Code.
History
1. Amendment filed 8-7-78; effecfive thirtieth day thereafter (Register 78, No.
32).
2. Amendment filed 10-31-78 as an emergency; designated effective 11-1-78
(Register 78, No. 44).
3. Certificate of Compliance filed 2-6-79 (Register 79, No. 6).
4. Amendment filed 5-17-79 as an emergency; effective upon filing (Register 79,
No. 20).
5. Certificate of Compliance filed 9-12-79 (Register 79, No. 37).
§ 50247. Twenty Percent Social Security Increase.
(a) The Twenty Percent Social Security Increase category includes
persons or families who were all of the following:
(1) Eligible for or receiving a cash grant in August J 972.
(2) Entitled to monthly Social Security benefits in August 1972.
(3) Discontinued from cash grant eligibility solely because of the 20
percent increase in Social Security benefits under PuWic Law 92-336.
(b) Persons or families considered to have been ehgible for or receiv-
ing a cash grant in August 1972 are those persons who were:
(1) Receiving a cash grant.
(2) Not receiving a cash grant due to adjustment for overpayment.
(3) Not receiving a cash grant because it had been suspended in order
to determine the amount of the grant.
(4) Not receiving an AFDC cash grant because their income was less
than the MBSAC but greater than the payment standard.
(5) Eligible for a cash grant but refused it.
(c) Persons or families considered to have been entitled to Social Secu-
rity benefits in August 1972, ar those persons who either:
(1) Received Social Security benefits in August 1972.
(2) Subsequently received Social Security benefits which included ret-
roactive payment for August 1972.
(d) Eligibility under this category shall be determined as follows:
(1) Establish that the conditions in (a) are met.
(2) Determine, on the Computation of SSP Payment for Adult Aid Re-
cipients, SSP 1 , or the AFDC Budget Worksheet, CA 241 , the net income
in accordance with SSI/SSP or AFDC regulations, whichever is appro-
priate.
(3) Subtract the amount of the 20 percent Social Security increase re-
ceived in October 1972 from the net income.
(4) If the amount determined in (3) is less than the MBSAC or the SSI/
SSP payment level, whichever is appropriate, the person is eligible under
this category.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.1 and 14050.1, Welfare and Institutions Code.
History
1. Amendment of subsection (d)(2) filed 8-7-78; effective thirtieth day thereafter
(Register 78, No. 32).
2. Amendment of subsection (d) filed 7-31-81 as an emergency; effective upon
filing. A Certificate of Compliance must be transmitted to OAL within 1 20 days
or emergency language will be repealed on 1 1-28-81.
3. Certificate of Compliance transmitted to OAL 11-6-81 and filed 1-27-82
(Register 82, No. 5).
§ 50249. Medically Needy Program.
NOTE; Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14005.3, Welfare and Institutions Code.
History
1. Amendment of subsection (a) filed 12-15-77; effecfive thirtieth day thereafter
(Register 77, No. 51).
2. Amendment of subsection (a)( 1 )(A) and (a)(2)(B) filed 8-7-78; effective thir-
tieth day thereafter (Register 78, No. 32).
3. Repealer filed 3-7-80 as an emergency; effective upon filing (Register 80, No.
9). A Certificate of Comphance must be transmitted to OAH within 120 days
or emergency language will be repealed on 7-6-80.
4. Certificate of Compliance filed 6-6-80 (Register 80, No. 23).
§ 50251 . Medically Indigent Program.
(a) A person under 2 1 years of age shall have eligibihty determined un-
der the Medically Indigent program if that person is any of the following:
(1) A person who cannot meet the eligibility requirements as a PA or
Other PA recipient, an MN person, or an MN family member.
(2) A person who is not an MN family member because of the exclu-
sion of a child from theMFBU.
(3) A child who is not living with a parent or relative and for whom a
public agency is assuming financial responsibility in whole or in part.
(4) A child receiving assistance under Aid tor Adoption of Children.
(5) A child who is not eligible as an AFDC MN person because the
child is not living with a relative.
(6) A person under 21 years of age who can qualify as an MN blind or
disabled person but chooses to apply as an MI person. The choice may
be made by a person acting on behalf of the person under 21 years of age.
(b) A person age 21 years or older shall have eligibility determined un-
der the Medically Indigent program if that person is all of the following:
(1) Underage 65.
(2) Unable to meet the eligibility requirements as PA or Other PA re-
cipient, an MN person, or an MN family member.
(3) Either pregnant or residing in a skilled nursing or an intermediate
care facility.
(c) In order to be eligible under this program, the persons listed in
(a)(1), (2), (5), (6) and (b) shall meet the property, ciuzenship, residence,
insritutional status and cooperation requirements specified in these regu-
lations.
(d) In order to be certified and receive a Medi-Cal card under this pro-
gram the persons Usted in (a)(1), (2), (5), (6) and (b) shall be determined
eligible and meet the income and share of cost requirements specified in
these regulafions.
(e) Children specified in (a)(3) shall be ehgible and certified for Medi-
Cal:
(1) On the basis of the information provided by the public agency on
form MC 250.
(2) Without considering the property or income of the child or the
child's parents.
(f) The children specified in (a)(4) above shall be eligible and certified
for Medi-Cal without any additional determinations by the county de-
partment.
(g) For purposes of tliis section:
Page 340.1
Register 96, Nos 8-9; 3-1-96
§ 50253
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
(1) Persons are considered 21 years of age on the first day of the month
following the month in which they reach age 21.
(2) Persons are considered 1 8 years of age on the first day of the month
in which they reach age 18.
NOTE: Authority cited: Sections 10723 and 14124.5, Welfare and Institutions
Code: Section 57(c). AB 799, Chapter 328, Statutes of 1982; and Section 87(c),
SB 20 12, Chapter 1594, Statutes of 1982. Reference: Sections 1 4005.4 and 14052,
Welfare and Institutions Code.
History
1. Amendment of subsections (a)(2), (a)(3). (a)(5). and adoption of subsection (0
filed 8-7-78; effective thirtieth day thereafter (Register 78, No. 32).
2. Amendment filed 2-5-80 as an emergency; effective upon filing (Register 80,
No. 6). A Certificate of Compliance must be transmitted to OAH within 120
days or emergency language will be repealed on 6-5-80.
3. Certificate ofCompliance transmitted to OAH 6^-80 and filed 6-6-80 (Reeis-
ter 80, No. 23).
4. Amendment of subsection (a)(4) filed 8-8-80; effecfive thirtieth day thereafter
(Register 80, No. 32).
5. Amendment filed l-8-81;effective thirtieth day thereafter (Register81,No.2).
6. Amendment of subsections (a)-(c) filed 3-24-82; effective thirtieth day there-
after (Register 82, No. 1 3).
7. Amendment filed 12-31-82 as an emergency; effective upon filing (Register
83, No. 2). A Certificate ofCompliance must be transmitted to OAL within 120
days or emergency language will be repealed on 4-30-83.
8. Certificate of Compliance transmitted to OAL 4-13-83 and filed 5-16-83
(Register83, No. 21).
§ 50253. Miscellaneous Special Programs.
Miscellaneous Special Programs are those specified in Sections 50255
through 50263.
NOTE; Authority cited: Secfions 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14142 and 14145, Welfare and Insfitutions Code.
History
1. Amendment filed 7-19-82; effective thirtieth day thereafter (Register 82, No.
30).
§ 50255. Repatriate Program.
Persons eligible for cash payments and other assistance under the Re-
patriate program shall not be eligible for Medi-Cal. Medi-Cal eligibility
may be established upon discontinuance from the program.
§ 50256. Qualified Disabled and Working Individual
Program.
(a) Eligibility Criteria: To receive Medi-Cal benefits under the Quali-
fied Disabled and Working Individual Program an eligible individual
must:
(1 ) Be entitled to enroll in Part A Medicare hospital insurance benefits
for the disabled and working, and
(2) Not have net nonexempt income that exceeds 200 percent of the
federal poverty level as defined by Section 50041.5. The qualifying in-
come level as defined in Section 50571 (the share of cost process for in-
curred medical expenses under Article 12 of this chapter) is not applica-
ble under this program, and
(3) Not have property that exceeds twice the resource limit as defined
by Section 50421.5.
(b) Period of Eligibility: Eligibility for the Qualified Disabled and
Working Individual Program shall be in accordance with Sections
50701, 50703 and 50710.
(c) Benefits: The Department shall pay Medicare Part A hospital pre-
miums for qualified disabled and working individuals as defined in Sec-
tion 50079.6.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Insfitutions
Code; and Section 12, Chapter 1430. Statutes of 1989. Reference: Section
14005.3, Welfare and Insfitutions Code; and Sections 1396a(a)(10)(E) and
1396d(s), Title 42, United States Code.
History
1. New section filed 10-3-94 as an emergency; operative 10-3-94 (Register 94,
No. 40). A Certificate ofCompliance must be transmitted to OAL by 1-31-95
or emergency language will be repealed by operation of law on the following
day.
2. Editorial correction of History Note 1 (Register 95, No. 9).
3. Repealed by operation of Government Code section 11346.1(g) (Register 95,
No. 9).
4. New section refiled 3-3-95 as an emergency; operative 3-3-95 (Register 95,
No. 9). A Certificate ofCompliance must be transmitted to OAL by 7-1-95 or
emergency language will be repealed by operation of law on the following day.
5. Certificate ofCompliance as to 3-3-95 order including amendment of section
and NOTi^ transmitted to OAL 2-22-95 and filed 4-5-95 (Register 95, No. 14).
§ 50257. Refugee Medical Assistance (RMA) and Entrant
Medical Assistance (EMA).
(a) Refugees and entrants who are not otherwise eligible for Medi-Cal
under federally-funded AFDC, SSI/SSP, MN or Medically Indigent
Child programs may be eligible for Medi-Cal through the special federal
programs of Refugee Medical Assistance (RMA) or Entrant Medical As-
sistance (EMA).
(b) Refugees and entrants who apply for Medi-Cal under the RMA or
EMA programs shall:
(1) Meet the definition contained in the Department of Social Services
(DSS) Manual of Policy and Procedures (MPP) of "refugee" (MPP sec-
tions 69.203.1 and 69.203.2), "children of refugees" (MPP section
69-203.3), or "entrant" (MPP sections 69-301 through 69-305).
(2) Have their eligibility for Medi-Cal under the RMA or EMA pro-
grams detennined in accordance with articles 4 through 1 3 (commencing
with section 50141) of this chapter; however, in-kind services and/or
shelter provided to refugees by a sponsor or resettlement agency are not
to be considered as income.
(3) Provide the name of the resettlement agency to the county welfare
department.
(c) Recipients of Refugee Cash Assistance (RCA) or Entrant Cash As-
sistance (ECA) shall automatically receive a Medi-Cal card. But receipt
of RCA/ECA is not a condition of RMA/EMA eligibility. Refugees may
apply for "RMA/FMA-Only" benefits.
(d) Recipients of RCA/ECA who become ineligible for these cash pro-
grams solely because of increased earnings from employment will con-
tinue to be eligible for up to eight months of transitional RMA/EMA
benefits with no share-of-cost. Eligibility for RMA/EMA is limited until
the end of the RMA/EMA time-eligibility period specified in subsection
(e) of this Section.
(e) Eligibility for Medi-Cal under the RMA or EMA programs shall
be limited to the shorter of the following periods:
(1) The refugee's first eight months of United States residency, begin-
ning with the month of entry, or the entrant's (including entrant children
bom in the United States resettlement camps) first eight months of parole
(release from Immigration and Naturalization Service custody).
(2) The time period for which DHS determines that sufficient federal
funds are available under the Refugee Resettlement Program (RRP) and
Cuban and Haitian Entrant Program (CHEP).
(f) Refugees shall be ineligible for RMA/EMA if:
(1) They have been denied or terminated from RCA/ECA for failure
or refusal to comply with registration, employment, education or training
requirements of MPP section 69-208; or
(2) They are full-time students in an institution of higher education,
as defined by MPP section 69-206.51, except where such enrollment is
part of an employability plan developed by a county welfare department
or its designee per MPP sections 69-206.52, 69-206.53, or 69-206.54,
or is part of a plan for an unaccompanied minor meeting the requirements
of sections 69-213.23 or 69-213.62.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; Section 57, Chapter 328, Statutes of 1982; and Section 87, Chapter 1594,
Statutes of 1982. Reference: Sections 14005.4 and 14011.5, Welfare and Institu-
tions Code; and Sections 400.90 through 400.156; 400.200 through 400.212, and
400.300 through 400.319, Title 45, Code of Federal Regulations.
History
1. Repealer and new section filed 12-31-82 as an emergency; effective upon filing
(Register 83, No. 2). A Certificate ofCompliance must be transmitted to OAL
within 120 days or emergency language will be repealed on 4-30-83.
2. Certificate of Compliance including editorial correction of subsection(b)(l)
transnutted to OAL 4-13-83 and filed 5-16-83 (Register 83, No. 21).
3. Amendment of subsections (b)(1) and (d)(1) filed 8-7-90; operative 9-6-90
(Register 90, No. 39).
Page 340.2
Register 96, Nos 8-9; 3-1-96
Title 22
Health Care Services
§ 50258
4. Amendment of section and Note filed 2-28-96; operative 3-29-96 (Register
96, No. 9).
§ 50258. Qualified Medicare Beneficiary Program.
(a) Eligibility Criteria: To receive Medi-Cal benefits under the Quali-
fied Medicare Beneficiary program an individual eligible for such bene-
fits must:
(1) Be entitled to Part A Medicare hospital insurance benefits, and
(2) Meet the qualifying income level as defined in section 50570 (the
share of cost process for incurred medical expenses under article 12 of
this chapter is not applicable under tliis program), and
(3) Meet the qualifying property (resource) limit as defined in section
50421.
(b) Period of Eligibility: Notwithstanding sections 50701, 50703 and
50710, eligibility for the Qualified Medicare Beneficiary Program shall
begin the first of the month following the month of approval.
(c) Benefits: The Department shall pay: Medicare premiums,
coinsurance, and deductibles for qualified Medicare beneficiaries as de-
fined in section 50079.7.
NOTE: Authority cited: Sections 10725, 14005.1 1 and 14124.5, Welfare and Insti-
tutions Code; and Section 1 2, Chapter 1 430, Statutes of 1 989. Reference: Sections
1396a(a) and 1 396d(p), Title 42, United States Code; and Section 1 4005. 1 1 , Wel-
fare and Institutions Code.
History
1. New section filed 8-13-90 as an emergency; operative 8-13-90 (Register 90,
No. 40). A Certificate of Compliance must be transmitted to OAL by 12-1 1-90
[The next page is 340.3.]
•
Page 340.2(a)
Register 96, Nos 8-9; 3-1-96
Title 22
Health Care Services
§ 50262
or emergency language will be repealed by operation of law on the following
day.
2. Certificate of Compliance transmitted to OAL 12-1 J-90 and filed 1-9-91
(Register 91, No. 8).
3. Amendment of subsection (c) filed 10-3-94 as an emergency; operative
10-3-94(Register94, No. 40). A Certificate of Compliance must be transmitted
to OAL by 1-31-95 oremergency language will be repealed by operation of law
on the following day.
4. Editorial cortection of History Note 3 (Register 95, No. 9).
5. Reinstatement of subsection (c) as it existed prior to emergency amendment
filed 3-2-95 by operation of Government Code section 1 1 346.1 (f) (Register 95,
No. 9).
6. Amendment of subsection (c) refiled 3-3-95 as an emergency; operative
3-3-95 (Register 95, No. 9). A Certificate of Compliance must be transmitted
to OAL by 7-1-95 oremergency language will be repealed by operation of law
on the following day.
7. Certificate of Compliance as to 3-3-95 order transmitted to OAL 2-22-95 and
filed 4-5-95 (Register 95, No. 14).
§ 50258.1. Specified Low-Income Medicare Beneficiary
Program (SLIVIB).
(a) Eligibility Criteria: A SLMB is ineligible as a QMB solely due to
excess income. To receive Medi-Cal benefits under the SLMB program
an individual eligible for such benefits must:
(1) Be entitled to Part A Medicare hospital insurance benefits, and
(2) Meet the qualifying income level as defined in Section 50570(b)
(the share of cost process for incurred medical expenses under Article 1 2
of this chapter is not applicable under this program), and
(3) Meet the qualifying property (resource) limit as defined in Section
50421.
(b) Period of Eligibility: Eligibility for the SLMB program shall begin
the first month eligibility is approved. A SLMB may be eligible for up
to three months of retroactive benefits from the month of application as
provided in Section 50710 but no earlier than January 1, 1993.
(c) Benefits: The Department shall pay Medicare Part B premiums for
SLMB as defined in Section 50091.5.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 1396a(a)(10)(E)(iii), Title 42, United States Code.
History
1. New section filed 12-21-93; operative 1-20-94 (Register 93, No. 52).
§ 50259. Indochinese Refugee Status.
NOTE; Authority cited: Sections 10554.1 and 14124.5, Welfare and Institutions
Code. Reference: Section 14005, Welfare and Institutions Code.
History
1 . Amendment filed 7-20-78 as an emergency; effective upon filing (Register 78,
No. 29).
2. Certificate of Compliance transmitted to OAH 11-16-78 and filed 1 1-17-78
(Register 78, No. 46).
3. Repealer filed 12-31-82 as an emergency; effective upon filing (Register 83,
No. 2). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 4-30-83.
4. Certificate of Compliance transmitted to OAL 4-13-83 and filed 5-16-83
(Register 83, No. 21).
§ 50260. 60-Day Postpartum Services Program.
A pregnant woman who was eligible for and received Medi-Cal dur-
ing the last month of pregnancy, shall continue to be eligible for all preg-
nancy related and postpartum services, for a 60-day period beginning on
the last day of pregnancy, regardless of whether the other conditions of
eligibility are met. Eligibility for this program ends on the last day of the
month in which the 60th day occurs.
NOTE: Authority cited: Sections 14105 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.3 and 14100.1, Welfare and Institutions Code;
and 42 United States Code Section 1396a (e) (5).
History
1. New section filed 1-4-88 as an emergency; operative 1^-88 (Register 88, No.
3). A Certificate of Compliance must be transmitted to OAL within 120 days or
emergency language will be repealed on 5-4-88.
2. Certificate of Compliance transmitted to OAL 4-28-88 and filed 5-31-88
(Register 88, No. 23).
§ 50261. Special Medi-Cal Dialysis Programs.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14140, 14141, 14142, 14143 and 14145, Welfare and
Institutions Code.
History
1 . Amendment filed 5-1 6-80 as an emergency; effective upon filing (Register 80,
No. 20). A Certificate of Compliance must be transmitted to OAH within 120
days or emergency language will be repealed on 9-14-80.
2. Certificate of Compliance filed 8-22-80 (Register 80, No. 34).
3. Repealer filed 3-25-81 as an emergency; effective upon filing (Register 81 , No.
13). A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on 7-23-81 (Register 81, No. 13).
4. Reinstatement of section as it existed prior to emergency repealer filed 3-25-81
by operation of Govemment Code Section 1 1346.1(f) (Register 82, No. 30).
5. Repealer filed 7-19-82; effective thirtieth day thereafter (Register 82, No. 30).
§ 50262. Special Zero Share of Cost Programs for
Pregnant Women and Infants.
The following eligibility criteria shall apply to pregnant women, and
infants under one year old with a share of cost. As used in this section the
terms "woman" and "women" mean any female regardless of age. Coun-
ties shall determine eligibility for applicants and beneficiaries under ei-
ther of the programs described in subsections (a)(1) and (a)(2). Eligibility
shall first be determined under subsection (a)(1).
(a) Eligibility criteria:
(1 ) 185 Percent Program. The net nonexempt Medi-Cal Family Bud-
get Unit (MFBU) income of an otherwise eligible pregnant woman, or
infant under one year old, shall be above the maintenance income need
level but shall not exceed 185 percent of the federal poverty level, as re-
vised annually in accordance with section 673(2) of the Omnibus Budget
Reconciliation Act of 1981 (Public Law 97-35).
(2) 200 Percent Program. The net nonexempt Medi-Cal Family Bud-
get Unit (MFBU) income of an otherwise eligible pregnant woman, or
infant under one year old, shall exceed 1 85 percent of the federal poverty
level as specified in (a)(l ) but shall not exceed 200 percent of the federal
poverty level, as revised annually in accordance with section 673(2) of
the Omnibus Budget Reconciliation Act of 1981 (Public Law 97-35).
(3) In determining net nonexempt income of the MFBU, all deductions
and exemptions applicable solely to AFDC-MN persons or families, as
provided in article 10, shall be allowed except health insurance pre-
miums.
(4) A pregnant woman or infant may not reduce MFBU income to the
185 or 200 percent level by meeting a share of cost.
(5) If the pregnant woman and/or infant meet the requirements of the
200 Percent Program, but have assets which exceed the resource Umit,
the assets shall be waived for those applicants or beneficiaries in accor-
dance with Section 50401(b).
(b) Period of EUgibility:
(1) Pregnant woman. Eligibility for the pregnant woman shall begin
no earlier than the first day of the month for which pregnancy is verified.
Eligibility shall end on the last day of the month of the 60-day period im-
mediately following the last day of pregnancy.
(2) Infant. Eligibility for an infant shall end upon attainment of age
one, unless the infant is an inpatient for whom medical services are pro-
vided during a continuous period which began before his/her first birth-
day. In that event, the infant shall continue to be eligible until the end of
the stay for which the inpatient services are furnished.
(3) Retroactive eligibility. Eligibility for a pregnant woman or infant
may be established retroactively in any of the three months immediately
preceding the month of application as provided in section 50710.
(c) Scope of Benefits:
(1) A pregnant woman shall be eligible only for pregnancy related ser-
vices, including services for conditions which complicate pregnancy.
(2) An otherwise eligible infant shall receive full Medi-Cal benefits
if the infant is a United States citizen or meets the requirements of section
14007.5 of the Welfare and Institutions Code, as added by Statutes of
1988, chapter 1441, Section 3. If the infant does not meet the require-
Page 340.3
Register 98, No. 47; 11-20-98
§ 50262.3
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
menls of this subsection, services shall be restricted to treatment of emer-
gency medical conditions only.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and ln.slitutions
Code. Reference: Sectioas 14007.5, 14148, 14148.1 and 14148.5, Welfare and In-
stitutions Code.
History
1 . New section tiled 6-27-89 as an emergency; operative 6-27-89 (Register 89,
No. 26). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 10-25-89.
2. Certificate of Compliance as to 6-27-89 order including change without regula-
tory effect of subsection (c)(2) transmitted to OAL 10-25-89 and filed
1 1-22-89 (Register 89, No. 48).
3. Amendment of subsections (a) and (b) filed 1-23-90 as an emergency; opera-
tive 1-23-90 (Register 90, No. 4). A Certificate of Compliance must be trans-
mitted to OAL within 120 days or emergency language will be repealed by oper-
ation of law on 5-23-90.
4. Certificate of Compliance as to 1-23-90 order including amendment trans-
mitted to OAL 5-22-90 and filed 6-21-90 (Register 90, No. 33).
5. Editorial correction of subsection (c) printing enor (Register 90, No. 33).
6. New subsection (a)(5) filed 5-28-92 as an emergency; operative 5-28-92 (Reg-
ister 92, No. 22). A Certificate of Compliance must be transmitted to OAL
9-25-92 or emergency language will be repealed by operation of law on the fol-
lowing day.
7. Certificate of Compliance as to 5-28-92 order transmitted to OAL 9-25-92 and
filed 10-19-92 (Register 92, No. 43).
§ 50262.3. Continued Eligibility Program for
Pregnant/Postpartum Women and Infants.
(a) A pregnant woman who has applied for, been determined eligible
for and is receiving Medi-Cal, shall continue to remain eligible for preg-
nancy-related services throughout the pregnancy and the 60-day post-
partum period beginning on the last day of pregnancy, regardless of any
increases in her family's income.
(b) Infants bom to women who are eligible for and receiving Medi-Cal
at the time of birth are automatically deemed eligible for one year without
a separate Medi-Cal apphcation and social security identification num-
ber. In addition, these infants shall remain eligible, regardless of any in-
creases in the family's income, as long as the following conditions con-
tinue to apply:
(1) the infant continues to hve with his/her mother; and
(2) the mother remains eligible for Medi-Cal or would have remained
eligible if she were still pregnant.
(c) Individuals described in (a) or (b) above must continue to meet all
other eligibility criteria.
NOTE: Authority cited: Sections 10725, 14016.1 and 14124.5, Welfare and Insti-
turions Code. Reference: Title 42, Sections 1396a(e)(4), 1396a(e)(5) and
1396a(e)(6) of the United States Code.
History
1. New section filed 4-27-94 as an emergency; operative 4-27-94 (Register 94,
No. 17). A Certificate of Compliance must be transmitted to OAL by 8-25-94
or emergency language will be repealed by operation of law on the following
day.
2. Certificate of Compliance as to 4-27-94 order transmitted to OAL 8-24-94 and
filed 9-29-94 (Register 94, No. 39).
3. Editorial correction of subsection (c) (Register 94, No. 39).
4. Editorial correction of Authority cite (Register 95, No. 43).
provided in article 10, shall be allowed except health insurance pre-
miums.
(3) A child may not reduce MFBU income to the 1 33 percent level by
meeting a share of cost.
(4) When determining eligibility for the 133 Percent Program, proper-
ty shall be disregarded in accordance with Section 50401(c).
(b) Period of Eligibility:
(1) Tlie period of eligibility for the 133 Percent program shall begin
no earlier than the first day of the month of the child' s first birthday unless
the child is an inpatient for whom medical services are provided during
a continuous period which began before his/her first birthday and he/she
remains eligible under the 1 85 or 200 percent program. Once the continu-
ous inpatient stay ends, the child must be evaluated for the 1 33 Percent
program if he/she has not attained age six.
(2) The period of eligibility for the 133 Percent program shall end on
the last day of the month in which the child attains age six unless the child
is an inpatient for whom medical services are provided during a continu-
ous period which began before his/lier sixth birthday. In that event, the
period of eligibility continues under the 133 Percent program until the
end of the stay for which the inpatient services are furnished so long as
the child would have remained ehgible under the 133 Percent program
but for attaining the age of six.
(c) Scope of Benefits:
(1) An otherwise eligible child shall receive full Medi-Cal benefits if
the child is a United States citizen or meets the requirements of section
50302. If the child does not meet the requirements of tliis section, ser-
vices shall be restricted to treatment of emergency medical conditions
only.
(2) Services provided under this section shall not be subject to any
share of cost requirements.
NOTE; Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.1, 14007.5, 14050.1 and 14148.75, Welfare and
Institutions Code; and Title 42, Sections 1395(a)(3)(E), 1396a(a)(10)(A)(i)(VI),
(e)(7), (/) and 1396b(v), United States Code.
History
1 . New section filed 10-01-90 as an emergency; operative 1 0-1 -90 (Register 90,
No. 45). A Certificate of Compliance must be transmitted by OAL by 1-29-91
or emergency language will be repealed by operation of law on the following
day.
2. Certificate of Compliance including amendment of subsections (a) and (c) trans-
mitted to OAL 1-28-91 and filed 2-19-91 (Register 91, No. 12).
3. Amendment of subsection (a), new subsection (a)(4), and amendment of Note
filed 4-2-98 as an emergency; operative 4-2-98. Submitted to OAL for print-
ing only pursuant to Welfare and Institutions Code section 14148.75 (Register
98, No. 16). A Certificate of Compliance must be transmitted to OAL by
9-29-98 or emergency language will be repealed by operation of law on the fol-
lowing day.
4. Amendment of subsection (a), new subsection (a)(4), and amendment of Note
refiled 4-15-98 as an emergency, including additional amendment of subsec-
tion (a)(4); operative 4-15-98. Submitted to OAL for printing only pursuant to
WelfareandlnstitutionsCodesectionl4]48.75(Register98,No. 16). A Certifi-
cate of Compliance must be transmitted to OAL by 1 0-12-98 or emergency lan-
guage will be repealed by operation of law on the following day.
5. Editorial correction of History 3 and History 4 (Register 98, No. 47).
6. Certificate of Compliance as to 4-15-98 order transmitted to OAL 1 0-9-98 and
filed 11-18-98 (Register 98, No. 47).
§ 50262.5. Special Zero Share of Cost Program for
Children of Age One Up to Age Six (133
Percent Program).
(a) Children who have attained one year of age but have not attained
six years of age are eligible to receive Medi-Cal benefits under the 133
Percent program if the following conditions are satisfied:
(1) The net nonexempt Medi-Cal Family Budget Unit (MFBU) in-
come of otherwise eligible children shall not exceed 133 percent of the
federal income official poverty line as defined by the Office of Manage-
ment and Budget, and revised annually in accordance with section 673(2)
of the Omnibus Budget Reconciliation Act of 1981 (Public Law 97-35).
(2) In determining net nonexempt income of the MFBU, all deductions
and exemptions applicable solely to AFDC-MN persons or families, as
§ 50262.6. Special Zero Share of Cost Program for
Children of Age Six Up to Age Nineteen (100
Percent Program).
(a) Children who have attained six years of age but have not attained
nineteen years of age are eligible to receive Medi-Cal benefits under the
100 Percent program if the following conditions are satisfied:
(1) The net nonexempt Medi-Cal Family Budget Unit (MFBU) in-
come of otherwise eligible children shall not exceed 100 percent of the
federal poverty level as defined in Section 50041.5.
(2) In determining net nonexempt income of the MFBU, all deductions
and exemptions applicable solely to AFDC-MN persons or families, as
provided in Article 10 of this chapter, shall be allowed except health in-
surance premiums.
Page 340.4
Register 98, No. 47; 11-20-98
Title 22
Health Care Services
§ 50264
•
(3) A child may not reduce MFBU income to the 100 percent level by
meeting a share of cost.
(4) When determining eligibility for the 1 00 Percent Program, proper-
ty shall be disregarded in accordance with Section 50401(c).
(5) Notwithstanding Section 50014, children are defined for this pro-
gram as persons under 19 years of age.
(b) Period of Eligibility:
(1) The period of eligibility for the 100 Percent program shall begin
no earlier than the first day of the month of the child's sixth birthday un-
less the child is an inpatient for whom medical services are provided dur-
ing a continuous period that began before his/her sixth birthday and he/
she remains eligible under Sections 50262 or 50262.5. Once the
continuous inpatient stay ends, the child must be evaluated for the 100
Percent program if he/she has not attained age nineteen.
(2) The period of eligibility for the 100 Percent program shall end on
the last day of the month in which the child attains age nineteen unless
the child is an inpatient for whom medical services are provided during
a continuous period that began before his/her sixth birthday. In that
event, the period of eligibility continues under the 100 Percent program
until the end of the stay for which the inpatient services are furnished so
long as the child would have remained eligible under the 100 Percent pro-
gram but for attaining the age of nineteen.
(c) Scope of Benefits:
(1) An otherwise eligible child shall receive full Medi-Cal benefits if
the child is a United States citizen or meets the requirements of Section
50301. If the child does not meet the requirements of this section, ser-
vices shall be restricted to treatment of emergency medical conditions
and pregnancy related services only.
(2) Services provided under this section shall not be subject to any
share of cost requirements.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.1, 14005.23, 14007.5, 14050.1 and 14148.75,
Welfare and Institutions Code; and Title 42, Sections 1395(a)(3)(E),
1396a(a)(10)(A)(i)(VII), (e)(7), (/), 1396b(v) and 1396(/)(1)(D), United States
Code.
History
1 . New section filed 10-26-95 as an emergency; operative 10-26-95 (Register95,
No. 43). A Certificate of Compliance must be transmitted to OAL by 2-23-96
or emergency language will be repealed by operation of law on the following
day.
2. Certificate of Compliance, as to 10-26-95 order including editorial correction
of subsection (b)(2), transmitted to OAL 2-21-96 and filed 3-20-96 (Register
96, No. 12).
3. Amendment of subsection (a), new subsections (a)(4) and (a)(5), and amend-
ment of subsection (b)(1) and Note filed 4-2-98 as an emergency; operative
4-2-98. Submitted to OAL for printing only pursuant to Welfare and Institu-
tions Code section 14148.75 (Register 98, No. 16). A Certificate of Compliance
must be transmitted to OAL by 9-29-98 or emergency language will be re-
pealed by operation of law on the following day.
4. Amendment of subsection (a), new subsections (a)(4) and (a)(5), and amend-
ment of subsections (b)(1) and Note refiled 4-15-98 as an emergency, includ-
ing additional amendment of subsection (a)(4); operative 4-15-98. Submitted
to OAL for printing only pursuant to Welfare and Institutions Code section
14148.75 (Register 98, No. 16). A Certificate of Compliance must be trans-
mitted to OAL by 10-12-98 or emergency language will be repealed by opera-
tion of law on the following day.
5. Editorial correction of History 3 and History 4 (Register 98, No. 47).
6. Certificate of Compliance as to 4-1 5-98 order transmitted to OAL 10-9-98 and
filed 11-18-98 (Register 98, No. 47).
§ 50262.7. Targeted Case Management Services Program.
NOTE: Authority cited: Sections 10725, 14105, 14124.5 and 14132.44, Welfare
and Institutions Code. Reference: Section 14132.44, Welfare and Institutions
Code.
History
1. New section filed 7-1-96; operative 7-1-96. Submitted to OAL for printing
only pursuant to Section 6, Chapter 305, Statutes of 1995 (Register 96, No. 27).
2. New section refiled 10-29-96 as an emergency; operative 10-29-96 (Register
96, No. 44). Submiued to OAL for printing only pursuant to Section 6, Chapter
305, Statutes of 1995. A Certificate of Compliance must be transmitted to OAL
by 2-26-97 or emergency language will be repealed by operation of law on the
following day.
3. Editorial correction of History 2 (Register 97. No. 15).
4. Repealed bv operation of Government Code section 1 1346.1(g) (Register 97,
No. 15).
5. New section filed 4-10-97; operative 4-10-97 pursuant to Government Code
section 11343.4(d) (Register 97, No. 15).
6. Change without regulatory effect renumbering former section 50262.7 to new
section 51365 filed 6-9-97 pursuant to section 100, title I. California Code of
Regulations (Register 97, No. 24).
§ 50263. MC 800 Program.
(a) The MC 800 program is an eligibility process that a county depart-
ment may choose to urihze to determine eligibility for persons receiving
health care services at either a county medical facility or a county con-
tract hospital. This process shall not be utilized unless the county depart-
ment executes a waiver agreeing to abide by payment adjustments made
pursuant to post-audits conducted by the Department, in accordance
with procedures established by the Director.
(b) If the county department chooses to utilize the MC 800 program,
persons who meet the requirements set forth in (c) shall be allowed to se-
lect one of the following methods of having their eligibility determined:
(1) The Medi-Cal application process, as specified in Article 4.
(2) The MC 800 process, in accordance with Department procedures.
(c) Persons who may have their eligibility determined in accordance
with the MC 800 program are those who meet the requirements of the MI
program and are all of the following:
(1) At least 21 years of age.
(2) Not eligible under any PA, Other PA, MN or special program.
(3) Not currently certified as a Medi-Cal beneficiary.
(4) Not applying for coverage for any health care services received
prior to admission to or receipt of services at the county medical facility
or county contract hospital.
(5) Not being transferred to a long-term care or private medical facil-
ity.
(6) Not eligible under another pubhc program that must bill Medi-Cal
for health care services provided to that program's beneficiaries.
History
1. Amendment of subsection (a) filed 8-7-78; effecuve thirtieth day thereafter
(Register 78, No. 26).
§ 50264. Medi-Cal Special Treatment Programs.
(a) Medi-Cal Special Treatment Programs consist of:
(1) The Medi-Cal Special Treatment Programs — Only:
(A) The Medi-Cal Dialysis Only program which covers persons who
are eligible under provisions of Arricle 17, only for dialysis and related
services.
(B) The Medi-Cal Parenteral Hyperalimentation Only program which
covers persons who are eligible under provisions of Article 17, only for
parenteral hyperalimentation and related services.
(2) The Medi-Cal Special Treatment Programs — Supplement:
(A) The Medi-Cal Dialysis Supplement program which covers per-
sons eligible under the Medically Needy or the Medically Indigent pro-
grams and who also meet the applicable eligibility requirements con-
tained in Article 17.
(B) The Medi-Cal Parenteral Hyperalimentation Supplement pro-
gram which covers persons who are eligible under the Medically Needy
or Medically Indigent programs and who also meet the applicable eligi-
bility requirements contained in Article 17.
NOTE: Authority cited: Sections 10725 and 14124.5. Welfare and Institutions
Code. Reference: Secfions 14140, 14141, 14142, 14143, 14144 and 14145, Wel-
fare and Insntutions Code.
[The next page is 341.]
Page 340.5
Register 98, No. 47; 11-20-98
Title 22
Health Care Services
§ 50273
•
History
1. New section filed 3-25-81 as an emergency; effective upon filing (Register 8J,
No. 13). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 7-23-8 1 .
2. Order of Repeal of 3-25-81 emergency order filed 4-3-81 by OAL pursuant
to Government Code Section 11349.6 (Register 81, No. 14).
3. New section filed 7-19-82; effecfive thirtieth day thereafter (Register 82, No.
30).
§ 50265. Medi-Cal Aid Codes.
(a) Aid codes shall be used in the classification and reporting of Medi-
Cal beneficiaries as required by the Department's written procedures.
History
1. Amendment filed 8-7-78; effective thirtieth day thereafter (Register 78, No.
32).
§ 50268. Tuberculosis (TB) Program.
(a) Eligibility Criteria: To be eligible under the Tuberculosis (TB) Pro-
gram an individual shall:
(1) Be diagnosed by a Medi-Cal provider as infected with TB as de-
fined in Section 51187.
(2) Have net nonexempt income as determined pursuant to Article 10
which does not exceed the maximum amount for a disabled individual as
provided in 42 United States Code Section 1396a(a)(lO)(A)(i).
(3) Have net nonexempt resources as determined pursuant to Article
9 which do not exceed the maximum amount for property reserve for a
disabled individual as under 42 United States Code Section
1396a(a)(10)(A)(i). These amounts are specified in Section 50420.
(4) Meet the citizenship, immigration status, and documentation re-
quirements for full Medi-Cal benefits as specified in Article 7.
(b) Period of Eligibility: Eligibility for the TB Program shall begin the
first month eligibility is approved. A person with TB may be eligible for
retroactive benefits in any of the three months immediately preceding the
month of application as provided in Section 50710, but not earher than
October 1, 1994.
(c) Benefits: TB infected individuals under this program shall be eligi-
ble only for TB related services as defined in Section 51355.
(d) Individuals eligible under this program shall have no share of cost.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Secfions 14059 and 14132, Welfare and Institutions Code.
History
1. New section filed 8-16-95 as an emergency; operative 8-16-95 (Register 95,
No. 33). A Certificate of Compliance must be transmitted to OAL by 12-14-95
or emergency language will be repealed by operafion of law on the following
day.
2. New section refiled 12-14-95 as an emergency; operative 12-14-95 (Register
95, No. 50). A Certificate of Compliance must be transmitted to OAL by
4-12-96 or emergency language will be repealed by operation of law on the fol-
lowing day.
3. New section refiled 4-8-96 as an emergency; operative 4-8-96 (Register 96,
No. 15). A Certificate of Compliance must be transmitted to OAL by 8-6-96
or emergency language will be repealed by operation of law on the following
day.
4. Certificate of Compliance as to 4-8-96 order, including amendment of subsec-
tion (a)(3), transmitted to OAL 7-30-96 and filed 9-11-96 (Register 96, No.
37).
Article 6. Institutional Status
§ 50271 . Institutional Status— General.
The status of being an inmate in public or private institutions shall be
a factor in the determination of Medi-Cal eligibility as specified in Sec-
tion 50273. The eligibility of inmates whose institutional status does not
cause ineligibility under Section 50273 shall be contingent upon all other
eligibility requirements being met.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 11014, 11016 and 14053, Welfare and Institutions
Code.
History
1 . Repealer and new section filed 4-2-83; effective thirtieth day thereafter (Regis-
ter 83, No. 14).
§ 50273. Medi-Cal Ineligibility Due to Institutional Status.
(a) Individuals who are inmates of public institutions are not eligible
for Medi-Cal: The following individuals are considered inmates of a
public institution:
(1 ) An individual in a prison, or a county, city, or tribal jail.
(2) An individual in a prison or jail: Prior to arraignment, prior to con-
viction, or prior to sentencing.
(3) An individual who is incarcerated, but can leave prison or jail on
work release or work furlough and must return at specific intervals.
(4) Individuals released from prison or jail due to a medical emergency
who would otherwise by incarcerated but for the medical emergency. In-
stitutional status of such persons is not affected by transfer to a public or
private medical facility.
(5) A minor in a juvenile detention center prior to disposition (judge-
ment) due to criminal activity of the minor.
(6) A minor, after disposition, placed in a detention or correctional fa-
cility, including a youth ranch, forestry camp, or home which is part of
the criminal justice system.
(7) A minor placed on probation by a juvenile court on juvenile inten-
sive probation with specific conditions of release, including residence in
a juvenile detention center.
(8) A minor placed on probation by a juvenile court on juvenile inten-
sive probation to a secure treatment facility contracted with the juvenile
detention center if the secure treatment facility is part of the criminal jus-
tice system.
(9) Individuals between the ages of 21-65 who are in an institution for
mental diseases shall be considered inmates of a public institution until
they are unconditionally released.
(b) Ineligibility for individuals classified as inmates in (a) begins on
the day institutional status commences and ends on the day institutional
status ends.
(c) The following individuals are not considered inmates of a public
institution and shall be eligible for Medi-Cal provided that all other re-
quirements for eligibility set out in this chapter are satisfied:
(1) An individual released from prison or jail on permanent release,
bail, own recognizance (OR), probation, or parole with a condition of:
(A) Home arrest;
(B) Work release;
(C) Community service;
(D) Outpatient treatment;
(E) Inpatient treatment.
(2) An individual who, after arrest but before booking, is escorted by
police to a hospital for medical treatment and held under guard.
(3) An individual in prison or jail who transfers temporarily to a half-
way house or residential treatment facility prior to a formal probation re-
lease order.
(4) An individual released from prison or jail under a court probation
order due to a medical emergency.
(5) A minor in a juvenile detention center prior to disposition (judg-
ment) due to care, protection or in the best interest of the child (e.g.. Child
Protective Services) if there is a specific plan for that person that makes
the stay at the detention center temporary. This would include those juve-
niles awaiting placement but still physically present in juvenile hall.
(6) A minor placed on probation by a juvenile court on juvenile inten-
sive probation with home arrest restrictions.
(7) A minor placed on probation by a juvenile court on juvenile inten-
sive probation to a secure treatment facility contracted with the juvenile
detention center if the secure treatment facility is not part of the criminal
justice system.
(8) A minor placed on probation by a juvenile court on juvenile inten-
sive probation with treatment as a condition of probation:
(A) In a psychiatric hospital;
(B) In a residential treatment center;
(C) As an outpatient.
Page 341
Register 96, No. 37; 9-13-%
§ 50275
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
(9) Individuals released from an institution for mental diseases or
transferred from such an institution to a public or private medical facility.
(10) Individuals on conditional release or convalescent leave from an
institution for mental diseases.
(11) Individuals under age 22 who are patients in an institution for
mental diseases, were institutionalized prior to their 21st birthday, and
continue to receive inpatient psychiatric care.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 11014, 11016 and 14053, Welfare and Institutions
Code; Sections 401 1 .1 and 401 5, Penal Code; 42 U .S.C. Section 1396d(a)(24)(A);
and 42 CFR Sections 435. 1 008 and 435. 1 009.
History
1. Repealer and new section filed 4-1-83 effective thirtieth day thereafter (Regis-
ter 83, No. 14). For prior history, see Register 77, No. 51.
2. Amendment filed 4-10-86; effective thirtieth day thereafter (Register 86, No.
15).
3. Amendment of subsections (c) and (d) filed 4-1 7-89; operative 5-17-89 (Reg-
ister 89, No. 48.)
4. Repealer and new section filed 1-26-95; operative 2-27-95 (Register 95, No.
4).
§ 50275. Voluntary Inmates.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Institufions
Code. Reference: Sections 11014, 11016 and 14053, Welfare and Institutions
Code.
History
] . Repealer filed 4-1-83; effective thirtieth day thereafter (Register 83, No. 14).
§ 50279. Limitations of Institutional Status.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 11014, 11016 and 14053, Welfare and Institutions
Code.
History
1 . Repealer filed 4-1-83; effecfive thirtieth day thereafter (Register 83, No. 14).
Article 7. Alienage, Citizenship and
Residence
§ 50301 . Citizenship or Immigration Status for Full
Medi-Cal Benefits.
(a) "Full Medi-Cal benefits" means all the services ordinarily covered
by the Medi-Cal program.
(b) To be eligible for full Medi-Cal benefits, an applicant or beneficia-
ry shall be a California resident who is one of the following:
(1) A citizen of the United States.
(2) A national of the United States from American Samoa or Swain's
Island.
(3) An alien who has been lawfully admitted to the United Stales for
permanent residence. This category includes "conditional permanent
resident" who have been granted a two-year period lawful admission for
of permanent residence in accordance with section 216 of the Immigra-
tion and Nationality Act (8 USC 1186a).
(4) An alien permanently residing in the United States under color of
law. (PRUCOL).
(5) An amnesty alien (lawful temporary resident or lawful permanent
resident) whose status has been adjusted in accordance with section 210,
210A or 245A of the Immigration and Nationality Act (8 USC sections
1160, 1 161 or 1255a) if the alien meets one of the following conditions:
(A) The alien is aged, blind, disabled, or under 18 years of age, or
(B) More than five years has elapsed since the date the alien was
granted lawful temporary resident stahis. The date of granting is the date
the alien filed his or her application for lawful temporary resident status.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; and Section 9, Chapter 1441, Statutes of 1988. Reference: Section 14007.5,
Welfare and Insfitutions Code.
History
1. Amendment filed 10-20-88 as an emergency; operative 10-20-88 (Register
88, No. 45). A Certificate of Compliance must be transmitted to OAL within 1 20
days or emergency language will be repealed on 2-20-89.
2. Amendment refiled 2-10-89 as an emergency; operadve 2-15-89 (Register 89,
No. 8). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 6-15-89.
3. Amendment refiled 6-5-89 as an emergency; operative 6-15-89 (Register 89.
No. 23). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 10-13-89.
4. Certificate of Compliance transmitted to OAL 10-12-89 and disapproved by
OAL on 1 1-13-89 (Register 89, No. 48).
5. Repealer and new section tiled 1 1-14-89 as an emergency pursuant to section
9 of chapter 1 441 of the Statutes of 1 988; operative 1 1-14-89 (Register 89, No.
48). A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on 3-14—90.
6. Repealer and new section refiled 3-8-90 as an emergency pursuant to section
9 of chapter 1441 of the Statutes of 1988; operative 3-13-90 (Register 90, No.
12). A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on 7-1 1-90.
7. Certificate of Compliance as to 3-8-90 order transmitted to OAL 7-5-90 and
disapproved 8-6-90 (Register 90, No. 42).
8. Repealer and new secfion filed 8-23-90 as an emergency pursuant to section
9 of chapter 1 441 of the Statutes of 1 988; operative 8-23-90 (Register 90, No.
42). A Certificate of Compliance must be transmitted to OAL by 12-21-90 or
emergency language will be repealed by operation of law on the following day.
9. Certificate of Compliance including amendment as to 8-23-90 order trans-
mitted to OAL 11-20-90 and filed 12-17-90 (Register 91, No. 5).
§ 50301 .1 . Documentation of Status as a Citizen or
National of the United States.
(a) Applicants in this classification shall present a document which es-
tablishes their identify, such as a driver's license, and an original docu-
ment which serves as evidence that an applicant is a citizen or national
of the United States.
(1) If the applicant declares a birthplace outside of the United States
or its outlying possessions, or
(2) If evidence exists which suggests that the applicant may be falsely
claiming to be a citizen or national of the United States.
(b) Documents which establish status as a citizen or national of the
U.S. include the following:
(1) A birth certificate issued by a governmental entity within the
United States or its outlying possessions.
(2) A United States passport.
(3) United States Citizen Identification Card (INS Form 1-197) or
Identification Card for Use of Resident Citizen in the United States
(1-179).
(4) Certificate of Naturalization (INS Form N-550 or N-570).
(5) Certificate of Citizenship (INS Form N-560 or N-561).
(6) Certification of Birth Abroad (Dept. of State Form FS-545 or
DS-1350).
(7) Report of Birth: Child Bom Abroad of American Parent or Parents
(Dept. of State Form FS-240).
(8) Northern Mariana Identification Card issued by INS to persons
bom in the Northern Mariana Islands who are now U.S. citizens.
(9) A religious document, of which the issuing organization has a re-
cord, showing that the birth took place in the U.S. Rehgious documents
shall be accepted only in the absence of other types of evidence.
(10) An Individual Fee Register Receipt (INS Form G-711) which
shows that the person has filed an Application for a New Naturalization
or Citizenship Paper (INS Form N-565).
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; and Section 9, Chapter 1441, Statutes of 1988. Reference: Sections 14011
and 14007.5, Welfare and Institufions Code.
History
1. New section filed 11-14-89 as an emergency pursuant to section 9 of chapter
1441 of the Statutes of 1988;operauve 11-14-89 (Register 89, No. 48). A Cer-
tificate of Compliance must be transmitted to OAL within 120 days or emergen-
cy language will be repealed on 3-14-90.
2. New section refiled 3-8-90 as an emergency pursuant to section 9 of chapter
1441 of the Statutes of 1988; operative 3-1 3-90 (Register 90, No. 12). A Certifi-
cate of Compliance must be transmitted to OAL within 120 days or emergency
language will be repealed on 7-11-90.
3. Certificate of Compliance as to 3-8-90 order transmitted to OAL 7-5-90 and
disapproved 8-6-90 (Register 90, No. 42).
4. Repealer and new section filed 8-23-90 as an emergency pursuant to section
9 of chapter 1441 of the Statutes of 1988; operafive 8-23-90 (Register 90, No.
42). A Certificate of Compliance must be transmitted to OAL by 12-21-90 or
emergency language will be repealed by operation of law on the following day.
Page 342
Register 96, No. 37; 9-13-96
Title 22 Health Care Services § 50301.2
5. Certificate of Compliance including amendment as to 8-23-90 order trans- driver's license, which establishes their identity and one or more of the
mitted to OAL 1 1-20-90 and filed 12-1 7-90 (Register 91 , No. 5). following documents-
§ 50301 .2. Documentation of Status as an Alien Lawfully (a) ^n Alien Registration Receipt Card (INS Form 1-551 or earlier
Admitted for Permanent Residence. Forms 1-151 of AR-3a).
Applicants in this classification shall present a document, such as a
•
[The next page is 343.]
•
Page 342.1 Register 96, No. 37; 9-13-96
Title 22
Health Care Services
§ 50301.3
•
(b) An Arrival-Departure Record (INS Form 1-94) or foreign passport
with a special stamp showing that an Alien Registration Receipt Card
(INS Form 1-551) will be issued.
(c) An INS Form 1-18 lb notification letter issued in connection with
an INS Form 1-181, Memorandum of Creation of Record of Lawful Per-
manent Residence, which shows that an Alien Registration Receipt Card
(INS Form 1-551) will be issued.
(d) A Permit to Re-enter the United States (INS Form 1-327).
(e) A letter from the Canadian Department of Indian Affairs, a birth or
baptismal record issued on a Canadian Indian reservation or tribal or
school records which establish that an American Indian bom in Canada
is of at least one half American Indian ancestry.
(f) An Individual Fee Register Receipt (INS Form G-71 1 ) for replace-
ment of a lost stolen or unreadable alien registration or alien admission
document listed in this section.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; and Section 9, Chapter 1441, Statutes of 1988. Reference: Sections 14011
and 14007.5, Welfare and Institutions Code.
History
1. New section filed 11-14-89 as an emergency pursuant to section 9 of chapter
1441 of the Statutes of 1988; operative 1 1-14-89 (Register 89, No. 48). A Cer-
tificate of Compliance must be transmitted to OAL within 1 20 days or emergen-
cy language will be repealed on 3-14-90.
2. New section refiled 3-8-90 as an emergency pursuant to section 9 of chapter
1441 of the Statutes of 1988; operative 3-13-90(Register 90, No. 12). A Certifi-
cate of Compliance must be transmitted to OAL within 1 20 days or emergency
language will be repealed on 7-11-90.
3. Certificate of Compliance as to 3-8-90 order transmitted to OAL 7-5-90 and
disapproved 8-6-90 (Register 90, No. 42).
4. Repealer and new section filed 8-23-90 as an emergency pursuant to section
9 of chapter 1441 of the Statutes of 1988; operative 8-23-90 (Register 90, No.
42). A Certificate of CompUance must be transmitted to OAL by 12-21-90 or
emergency language will be repealed by operation of law on the following day.
5. Certificate of Compliance as to 8-23-90 order transmitted to OAL 1 1-20-90
and filed 12-17-90 (Register 91, No. 5).
§ 50301 .3. Documentation of Status as an Alien
Permanently Residing in the United States
Under Color of Law (PRUCOL).
Applicants in this classification shall present a document which esta-
blishes their identity, such as a driver's license, and one or more of the
following INS-issued documents:
(a) Aliens admitted to the United States before April 1, 1980 in accor-
dance with Immigration and Nationality Act (INA) section 203(a)(7) (8
use 1 153(a)(7)): Arrival-Deparmre Record, INS Form 1-94. annotated
'REFUGEE-CONDITIONAL ENTRY."
(b) Aliens paroled into the United States for an indefinite period in-
cluding Cuban/Haitian Entrants and Publiclnterest/Humanitarian Parol-
ees: INS Form 1-94, with notation that the alien has been paroled into the
United States pursuant to INA section 212(d)(5) (8 USC 1182(d)(5)) or
stamped "Cuban/Haitian Entrant (Status Pending) reviewable January
15, 1981. Employment authorized until January 15, 1981".
(c) Aliens subject to an Order of Supervision: INS Form 1-220B.
(d) Aliens granted an indefinite stay of deportation: INS Form 1-94 or
a letter from INS showing this status.
(e) AHens granted an indefinite voluntary departure: INS Form 1-94
or a letter from INS showing this status.
(f) Aliens on whose behalf an INS Form 1-130 (Petition to Classify
Status of Alien Relative for Issuance of Immigrant Visa) has been filed,
with their families covered by the petition, who are entitled to voluntary
departure but whose departure INS does not contemplate enforcing: INS
Form 1-94 showing this status or Alien Voluntary Departure Notice, INS
Form 1-210.
(g) Aliens who have filed applications for adjustment to lawfully ad-
mitted for permanent residence status that INS has accepted as "properly
filed": an INS Form 1-181 Memorandum of Creation of Record of Law-
ful Permanent Residence, an INS For 1-94 (Arrival-Departure Record)
stamped I&NA section 245 Applicant, or a properly endorsed U.S. pass-
port.
(h) Aliens granted a stay of deportation for a specific period by court
order, statute or regulation, or by individual determination of INS in ac-
cordance with INA section 1 06 (8 USC 1 105a) or relevant INS Operating
Instruction and whose departure INS does not contemplate enforcing:
INS Form 1-94, a letter from INS, or an order issued by a District Director
of INS, the Executive Office of Immigration Review, or a federal court.
(i) Aliens granted asylum in accordance with INA secfion 208 (8 USC
1 1 58): INS Form 1-94 and a letter from INS showing this status.
(j) Aliens admitted as refugees since April 1 , 1980: Arrival-Departure
Record, INS Form 1-94, amiotated: "ADMITTED AS A REFUGEE
PURSUANT TO SECTION 207 OF THE IMMIGRATION AND NA-
TIONALITY ACT" or an unexpired Refugee Travel Document, INS
Form 1-571.
(k) Aliens granted voluntary departure, whose departure INS does not
contemplate enforcing: INS Form 1-94 showing this status or Alien Vol-
untary Departure Notice, INS Form 1-210 bearing a departure date.
(/) Aliens in deferred action status pursuant to INS operating instruc-
tions: Alien Voluntary Departure Notice, INS Form 1-210 or a letter from
INS showing this status.
(m) Aliens who have applied for an adjustment of status from undocu-
mented alien to alien lawfully admitted for permanent residence in accor-
dance with INA section 249 (8 USC 1259) on the basis of having entered
and continuously resided in the United States since before January 1 ,
1972: Individual Fee Register Receipt, INS Form G-711 and an Inter-
view Appointment Letter, INS Form 1^68.
(n) Aliens who have been granted suspension of deportation in accor-
dance with INA section 244 (8 USC 1254) whose departure INS does not
contemplate enforcing: Arrival-Departure Record, INS Form 1-94 and
an order issued by the Executive Office of Immigration Review.
(o) Aliens who deportation is being withheld in accordance with INA
section 243(h) (8 USC 1253(h)): Arrival-Departure Record, INS Form
1-94 and an order issued by the Executive Office of Immigration Review.
(p) Citizens of the Republic of the Marshall Islands or the Federated
States of Micronesia who, in accordance with 48 USC sections 1681
through 1695, may live, work or study in the United States without re-
strictions: Arrival-Departure Record, INS Form 1-94 annotated "CFA/
MIS" or "CFA/FSM."
(q) Aliens granted extended voluntary departure for a specified time
due to conditions in their home countries: Arrival-Departure Record,
INS Form 1-94 showing this status or Ahen Voluntary Departure Nofice,
INS Form 1-210.
(r) Aliens whose INS documents have been lost or stolen or are unread-
able: An Individual Fee Register Receipt (INS Form G-711) which
shows the person has applied for replacement of a lost, stolen or unread-
able alien registration or alien admission document listed in this section.
(s) Aliens living in the United States with the knowledge and permis-
sion of INS whose departure that agency does not contemplate enforcing:
INS documents which establish these facts.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; and Section 9, Chapter 1441, Statutes of 1 988. Reference: Sections 14007.5
and 14011, Welfare and Institutions Code.
History
1. New section filed 1 1-14-89 as an emergency pursuant to section 9 of chapter
1441 of the Statutes of 1988; operative 1 1-14-89 (Register 89, No. 48). A Cer-
tificate of Compliance must be transmitted to OAL within 1 20 days or emergen-
cy language will be repealed on 3-14-90.
2. New .secfion refiled 3-8-90 as an emergency pursuant to section 9 of chapter
1441 of the Statutesof 1988; operative 3-13-90 (Register 90, No. 12). ACertifi-
cate of Compliance must be transmitted to OAL within 1 20 days or emergency
language will be repealed on 7-11-90.
3. Certificate of Compliance as to 3-8-90 order transmitted to OAL 7-5-90 and
disapproved 8-6-90 (Register 90, No. 42).
4. Repealer and new section filed 8-23-90 as an emergency pursuant to section
9 of chapter 1441 of the Statutes of 1988; operative 8-23-90 (Register 90, No.
42). A Certificate of Compliance must be transmitted to OAL by 12-21-90 or
emergency language will be repealed by operation of law on the following day.
5. Certificate of Compliance including amendment as to 8-23-90 order trans-
mitted to OAL 1 1-20-90 and filed 12-17-90 (Register 91 , No. 5).
Page 343
Register 95, No. 45; 11-10-95
§ 50301.4
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
§ 50301 .4. Documentation of Status as an Amnesty Alien.
(a) Aliens whose status has been adjusted in accordance with Immigra-
tion and Nationality Act sections 210, 210A or 254A (8 USC sections
1160, 1 161 or 1255a) who are applying for full Medi-Cal benefits shall
present one of the following INS documents:
(1) Aliens granted lawful temporary resident status: Temporary Resi-
dent Card, INS Form 1-688.
(2) Aliens granted lawful permanent resident status: Alien Registra-
tion Receipt Card, INS Form 1-551 or an INS Form 1-688 with a sticker
on the back which reads "Temporary evidence of lawful admission for
permanent residence and employment authorization. Valid for 1 year
from the expiration date on the reverse of this 1-688 Form 1-688 Ext."
(3) Aliens whose INS documents have been lost or stolen or are un-
readable: An individual Fee Register Receipt (INS Form G-71 1) which
shows the person has applied for replacement of a lost, stolen or unread-
able 1-688 or 1-551.
(4) Aliens who were issued an 1-688 extension sticker wliich subse-
quently was lost or stolen or which became unreadable: an 1-94 (Arrival-
Departure Record) with the stamp: "PROCESSED FOR 1-551. TEMPO-
RARY EVIDENCE OF LAWFUL ADMISSION FOR PERMANENT
RESIDENCE. VALID UNTIL ." (The expiration date
is one year from the date lawful permanent residence status was granted.)
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; and Section 9, Chapter 1 441, Statutes of 1 988. Reference: Sections 14007.5
and 140 11, Welfare and institutions Code.
History
1 . New section filed 1 1-14-89 as an emergency pursuant to section 9 of chapter
1441 of the Statutes of 1988; operative 1 1-14-89 (Register 89, No. 48). A Cer-
tificate of Compliance must be transinitted to OAL within 120 days or emergen-
cy language will be repealed on 3-14-90.
2. New section refiled 3-8-90 as an emergency pursuant to section 9 of chapter
1441 of the Statutes of 1988; operative 3-1 3-90 (Register90. No. 12). A Certifi-
cate of Compliance must be transmitted to OAL within 1 20 days or emergency
language will be repealed on 7-11-90.
3. Certificate of Compliance as to 3-8-90 order transmitted to OAL 7-5-90 and
disapproved 8-6-90 (Register 90, No. 42).
4. Repealer and new section filed 8-23-90 as an emergency pursuant to section
9 of chapter 1441 of the Statutes of 1988; operative 8-23-90 (Register 90, No.
42). A Certificate of Compliance must be transmitted to OAL by 12-21-90 or
emergency language will be repealed by operation of law on the following day.
5. Certificate of Compliance including amendment as to 8-23-90 order trans-
mitted to OAL 11-20-90 and filed 12-17-90 (Register 91, No. 5).
§ 50301 .5. Opportunity to Document Satisfactory
Immigration Status.
(a) Alien applicants for full Medi-Cal benefits must present docu-
ments from INS or an order issued by the District Director of INS, the Ex-
ecutive Office of Immigration Review, or a federal court which serve as
reasonable evidence of satisfactory immigration status for Medi-Cal
purposes. After they are informed of this fact, they shall have 30 calendar
days, or the time it actually takes the county department to process their
Medi-Cal applications, whichever is longer, to submit such documents.
The 30-day period begins at the time the applicant submits a completed
form MC 13 (5/89) containing a declaration in writing, under penalty of
perjury, which attests to his or her status as an alien.
(b) Applicants who do not present documentation indicating satisfac-
tory immigration status within the period prescribed in subsection (a), are
eligible for restricted Medi-Cal benefits if they meet all other program
requirements.
(c) The county department shall provide adequate notice to the indi-
vidual of any adverse action and shall accord to the individual an oppor-
tunity for a hearing in accordance with the Department of Social Services
Manual of Policies and Procedures sections 22-017, 22-021 and
22-022.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institufions
Code; and Section 9, Chapter 1441, Statutes of 1988. Reference: Sections 10950
to 10965, inclusive, 14007.5 and 1401 1, Welfare and Institufions Code.
History
1 . New section filed 1 1-14-89 as an emergency pursuant to section 9 of chapter
1441 of the Statutes of 1988; operafive 1 1-14-89 (Register 89, No. 48). A Cer-
tificate of Compliance must be transmitted to OAL within 120 days or emergen-
cy language will be repealed on 3-14-90.
2. New section refiled 3-8-90 as an emergency pursuant to section 9 of chapter
1441 of the Statutes of 1988; operative .3-1 3-90 (Register 90. No. 12). A Certifi-
cate of Compliance must be transmitted to OAL within 120 days or emergency
language will be repealed on 7-1 1-90.
3. Certificate of Compliance as to 3-8-90 order transmitted to OAL 7-5-90 and
disapproved 8-6-90 (Register 90, No. 42).
4. Repealer and new section filed 8-23-90 as an emergency pursuant to secfion
9 of chapter 1441 of the Statutes of 1988; operative 8-23-90 (Register 90, No.
42). A Certificate of Compliance must be transmitted to OAL by 12-21-90 or
emergency language will be repealed by operation of law on the following day.
5. Certificate of Compliance including amendment as to 8-23-90 order trans-
mitted to OAL 1 1-20-90 and filed 12-17-90 (Register 91. No. 5).
§ 50301 .6. Verification of Satisfactory Immigration Status.
(a) "Satisfactory immigration status" for Medi-Cal purposes means
lawful admission for permanent residence in the United States, status as
an alien permanently residing in the U.S. under color of law, or status as
an amnesty alien.
(b) The authenticity of all INS-issued documents presented as reason-
able evidence of such status shall be verified through the Systematic
Alien Verification of Entitlements (SAVE) system operated by INS or by
direct contact with INS officials.
(c) Applicants for full Medi-Cal benefits who have declared them-
selves to be aliens, must also declare in writing whether, to the best of
their knowledge and belief, they have a satisfactory immigration status.
Such aliens shall present INS-issued documents which indicate their sta-
tus. At least one of these documents should contain an alien registration
or alien admission number.
(d) A primary SAVE system verification shall be used to access the
biographical/immigration status computer record contained in the Alien
Status Verification Index maintained by INS. This procedure shall be
used to verify the status of all aliens claiming satisfactory immigration
status who present an INS-issued document which contains an alien reg-
istration or alien admission number.
(e) The secondary SAVE system verification procedure shall be used
to forward copies of original INS documents in cases where:
(1) A primary check of the Alien Status Verification Index instructs
the county department to "Institute secondary verification."
(2) The document presented indicates immigration status but does not
include an alien registration or alien admission number.
(3) The Alien Status Verificadon Index record includes the alien regis-
tration or admission number on the document presented by the alien but
does not match other information contained in the document.
(4) The document is suspected to be counterfeit or to have been altered.
(5) The document includes an alien registration number in the A60 000
000 (not yet issued) or A80 000 000 (illegal border crossing) series.
(6) The document is a fee receipt from INS for replacement of a lost,
stolen or unreadable INS document.
(7) The document is one of the following: an INS Form 1-1 8 lb notifi-
cation letter issued in connection with an INS Form I-l 81 Memorandum
of Creadon of Record of Permanent Residence, an Arrival-Departure
Record (INS Form 1-94) or a foreign passport stamped "PROCESSED
FOR 1-551, TEMPORARY EVIDENCE OF LAWFUL PERMANENT
RESIDENCE" that INS issued more than one year before the date of
applicadon for Medi-Cal.
(f) The status of amnesty ahens who are eligible only for restricted
Medi-Cal benefits because they are not aged, blind, disabled or under 18
years of age, shall be verified through the SAVE system; provided, how-
ever, that the county department shall not require or request an applicant
for or beneficiary of restricted Medi-cal benefits to disclose their citizen-
ship or immigradon status, birthplace, country of citizenship, alien regis-
tration number and/or ahen admission number, date of first entry into the
United States, name upon first entry into the United States, or whether
they have a Social Security Number.
(g) Full Medi-Cal benefits received pending completion of a determi-
nation of immigradon status by INS shall be reduced to restricted Medi-
Cal benefits upon receipt of notice from the SAVE system, from an INS
Page 344
Register 95, No. 45; 11-10-95
Title 22
Health Care Services
§ 50302.2
•
official, or the applicant/beneficiary of a lack of satisfactory immigration
status.
(h) The county department shall provide adequate notice to the indi-
vidual of any adverse action and shall accord to the individual an oppor-
tunity for a hearing in accordance with the Department of Social Services
Manual of Policies and Procedures and Procedures sections 22-017,
22-021 and 22-022.
NOTE: Authority cited: Sections 10725 and 14] 24.5, Welfare and Institutions
Code; and Section 9, Chapter 1441, Statutes of 1988. Reference: Sections 10950
to 10965, inclusive, 14007.5 and 1401 1, Welfare and Institutions Code; and the
Crespin v. Kiz.er court order (Alameda County Superior Court, December 16,
1992).
History
1. New section filed 1 1-14-89 as an emergency pursuant to section 9 of chapter
1441 of the Statutes of 1988; operative 11-14-89 (Register 89, No. 48). A Cer-
tificate of Compliance must be transmitted to OAL within 1 20 days or emergen-
cy language will be repealed on 3-14-90.
2. New section refiled 3-8-90 as an emergency pursuant to section 9 of chapter
1 44 1 of the Statutes of 1988; operative 3-1 3-90 (Register 90, No. 12). A Certifi-
cate of Compliance must be transmitted to OAL within 120 days or emergency
language will be repealed on 7-1 1 -90.
3. Certificate of Compliance as to 3-8-90 order transmitted to OAL 7-5-90 and
disapproved 8-6-90 (Register 90, No. 42).
4. Repealer and new section filed 8-23-90 as an emergency pursuant to secfion
9 of chapter 1441 of the Statutes of 1988; operative 8-23-90 (Register 90, No.
42). A Certificate of Compliance must be transmitted to OAL by 12-21-90 or
emergency language will be repealed by operation of law on the following day.
5. Certificate of Compliance including amendment as to 8-23-90 order trans-
mitted to OAL 1 1-20-90 and filed 12-17-90 (Register 91, No. 5).
6. Amendment of subsecfion (f) and Note filed 5-17-93 as an emergency with
Secretary of State by the Department of Health Services; operafive 5-17-93.
Submitted to OAL forprintinsr only pursuant to 1992 Senate Bill 485 (Register
93, No. 21).
§ 50302. Restricted Medi-Cal Benefits for Certain Aliens.
(a) "Restricted Medi-Cal benefits" to certain applicants and beneficia-
ries means program-covered services to treat an emergency medical con-
dition as defined in section 14007.5(d) of the Welfare and Institutions
Code and section 440.255 of title 42 of the Code of Federal Regulations,
and pregnancy-related services, as defined in section 1(g) of chapter
1441 of the Statutes of 1988 and section 440.255 of title 42 of the Code
of Federal Regulations.
(b) To be eligible for restricted Medi-Cal benefits, an Applicant or
beneficiary shall be a California resident, as specified in section 50320,
who is one of the following:
(1) An alien who lacks a document from INS or an order issued by a
District Director of INS, the Executive Office of Immigration Review,
or a federal court that serves as reasonable evidence of satisfactory immi-
gration status.
(2) A nonimmigrant alien legally admitted to the U.S. for a limited pe-
riod.
(3) An amnesty alien whose status has been adjusted to lawful tempo-
rary resident or lawful permanent resident in accordance with section
210, 210A, or 245A of the Immigration and Nationality Act (8 USC sec-
tion 1160, 1161, or 1255a) who is not eligible for full Medi-Cal benefits
under these regulations.
(c) Alien applicants for restricted Medi-Cal benefits who lack docu-
mentation of satisfactory immigration status or who are nonimmigrant
aliens shall meet all other requirements for program eligibility except for
possessing or having applied for an SSN.
(d) Applicants for restricted Medi-Cal benefits who are amnesty al-
iens must possess or have applied for an SSN.
(e) The Systematic Alien Verification for Entitlements (SAVE) sys-
tem operated by INS shall not be used to verify the immigration status of
persons applying for restricted Medi-Cal benefits unless these persons
indicate that they are amnesty aliens.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Institutions
Code; and Section 9, Chapter 1441, Statutes of 1988. Reference: Secfions 14007.5
and 1401 1, Welfare and Institutions Code.
History
I. New section filed 1 1-14-89 as an emergency pursuant to section 9 of chapter
1441 of the Statutes of 1988; operative 1 1-14-89 (Register 89, No. 48). A Cer-
tificate of Compliance must be transmitted to OAL within 120 days or emergen-
cy language will be repealed on 3-14-90.
2. New secfion refiled 3-8-90 as an emergency pursuant to section 9 of chapter
1 44 1 of the Statutes of 1 988; operafive 3-1 3-90 (Register 90, No. 1 2). A Certifi-
cate of Compliance must be transmitted to OAL wirhin 1 20 days or emergency
language will be repealed on 7-1 1-90.
3. Certificate of Compliance as to 3-8-90 order transmitted to OAL 7-5-90 and
disapproved 8-6-90 (Register 90, No. 42).
4. Repealer and new secfion filed 8-23-90 as an emergency pursuant to section
9 of chapter 1441 of the Statutes of 1988; operative 8-23-90 (Register 90, No.
42). A Certificate of CompHance must be transmitted to OAL byl 2-2 1-90 or
emergency language will be repealed by operation of law on rhe following day.
5. Certificate of Compliance including amendment as to 8-23-90 order trans-
mitted to OAL 11-20-90 and filed 12-17-90 (Register 91, No. 5).
§ 50302.1. Limitations on Medi-Cal Benefits for Aliens.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institufions
Code. Reference: Sections 41 1, 431 and 432 of the Personal Responsibility and
Work Opportunity Reconciliation Act of 1996 (Pub.L. 104-193); Sections 501
and 508 of Division C (the "Immigration Reform and Immigrant Responsibility
Act of 1996") of the Omnibus Consolidated Appropriations Act, 1997 (Pub.L
104-208); Sections 5302, 5562, 5571 and 5581 of the Balanced Budget Act of
1997 (Pub.L. 1 05-33) as amended by Sections 401 and 403 of the Taxpayer Relief
Act of 1 997 (Pub.L. 105-34.); 8 USC Sections 1 1 01 (a)( 1 5) and 1 62 1 (b); Sections
14007.5 and 1401 1, Welfare and Institufions Code; and Secfion 1, Chapter 1441,
Statutes of 1988.
History
1 . New section filed 1 1-5-96 as an emergency; operative 12-1-96 (Register 96,
No. 45). A Certificate of Compliance must be transmitted to OAL by 3-31-97
or emergency language will be repealed by operation of law on the following
day.
2. Repealed by operation of Government Code secfion 1 1346.1(g) (Register 97,
No. 49).
3. New secfion filed 12-1-97; operative 12-1-97 pursuant to Government Code
section 11343.4(d) (Register 97, No. 49).
4. Change without regulatory effect repealing section filed 10-5-99 pursuant to
secfion 100, tifie 1, California Code of Regulafions (Register 99, No. 41).
§ 50302.2. Limitations on Medi-Cal Benefits for Aliens.
(a) Pursuant to Section 41 1 of the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996 (8 USC section 161 1), and not-
withstanding any other provision of this division, aliens who are not qual-
ified aliens, nonimmigrant aliens under the Immigration and Nationality
Act (INA) (8 USC section 1 101 et seq.), or aliens paroled into the United
States under Section 212(d)(5) of the INA (8 USC section 1182(d)(5)),
for less than one year, are not eligible to receive the state-only funded
long-term care services described in subdivision (f) of Secfion 1 of Chap-
ter 1441 of the Statutes of 1988.
(b) A qualified alien is an alien who, at the time he or she applies for,
receives, or attempts to receive a public benefit, is any of the following:
(1) An alien lawfully admitted for permanent residence under the IN A
(8 USC section 1101 et seq.).
(2) An alien who is granted asylum under Section 208 of the INA (8
USC secfion 1 158).
(3) A refugee who is admitted to the United States under Secfion 207
of the INA (8 USC secfion 1 157).
(4) An alien who is paroled into the United States under Secfion
212(d)(5) of the INA (8 USC secfion 1182(d)(5)) for a period of at least
one year.
(5) An alien whose deportafion is being withheld under Secfion 243(h)
of the INA as in effect immediately before the effecfive date of Secfion
307 of Division C of Pubfic Law 104-208 or Secfion 241(b)(3) of the Act
(as amended by Secfion 305(a) of Division C of Public Law 104-208).
(6) An alien who is granted condifional entry pursuant to Secfion
203(a)(7) of the INA as in effect prior to April 1 , 1980. (See editorial note
under 8 USC section 1101, "Effecfive Date of 1980 Amendment".)
(7) An ahen who is a Cuban and Haitian entrant (as defined in Section
501(e) of the Refugee Educafion Assistance Act of 1980).
(8) An alien who meets all of the conditions of subparagraphs (A), (B),
(C), and (D) below:
(A) The alien has been battered or subjected to extreme cruelty in the
United States by a spouse or a parent, or by a member of the spouse's or
parent's family residing in the same household as the alien, and the
spouse or parent of the alien consented to, or acquiesced in, such battery
or cruelty.
Page 345
Register 99, No. 41; 10-8-99
§ 50302.2
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
(B) There is a substantial connection between such battery or cruelty
and the need for the benefits to be provided.
(C) The alien has been approved or has a petition pending which sets
forth a prima facie case for:
J. status as a spouse or child of a United States citizen pursuant to
clause (ii), (iii), or (iv) of Section 204(a)(1)(A) of the INA (8 USC section
1154(a)(1)(A)),
2. classification pursuant to clause (ii) or (iii) of Section 204(a)(1)(B)
of the INA (8 use section 1154),
3. suspension of deportation and adjustment of status pursuant to Sec-
tion 244(a)(3) of the INA (8 USC section 1 254), as in effect prior to April
1, 1997,
4. status as a spouse or child of a United States citizen pursuant to
clause (i) of Section 204(a)(1)(A) of the INA (8 USC section
1154(a)(1)(A)) or classification pursuant to clause (i) of Section
204(a)(1)(B) of the INA (8 USC section 1 154(a)(1)(B)), or
5. Cancellation of removal pursuant to Section 240A(b)(2)of thelNA.
(D) For the period for which benefits are sought, the individual respon-
sible for the battery or cruelty does not reside in the same household or
family eligibihty unit as the individual subjected to the battery or cruelty.
(9) An alien who meets all of the conditions of subparagraphs (A), (B),
(C), (D) and (E) below:
(A) The alien has a child who has been battered or subjected to extreme
cruelty in the United States by a spouse or a parent of the alien (without
the active participation of the alien in the battery or caielty), or by a mem-
ber of the spouse's or parent's family residing in the same household as
the alien, and the spouse or parent consented or acquiesced to such bat-
tery or cruelty.
(B) The alien did not actively participate in such battery or cruelty.
(C) There is a substantial connection between such battery or cruelty
and the need for the benefits to be provided.
(D) The alien meets the requirements of subsection (b)(8)(C) above.
(E) For the period for which benefits are sought, the individual respon-
sible for the battery or cruelty does not reside in the same household or
family eligibility unit as the child subjected to the battery or cruelty.
(10) An alien child who meets all of the conditions of subparagraphs
(A), (B), and (C) below:
(A) The alien child resides in the same household as a parent who has
been battered or subjected to extreme cruelty in the United States by that
parent's spouse or by a member of the spouse's family residing in the
same household as the parent and the spouse consented or acquiesced to
such battery or cruelty.
(B) There is a substantial connection between such battery or cruelty
and the need for the benefits to be provided.
(C) The alien child meets the requirements of subsection (b)(8)(C)
above.
(c) For purposes of this section, there is a "substantial connection be-
tween such battery or cruelty and the need for benefits to be provided"
if the alien declares, and the county welfare department verifies, any of
the following circumstances:
(1) The alien or the alien's child is receiving cash assistance based on
battery or extreme cruelty;
(2) The benefits are needed due to a loss of financial support resulting
from the alien's and/or his or her child's separation from the abuser;
(3) The benefits are needed because the alien or his or her child re-
quires medical attention or mental health counseling, or has become dis-
abled, as a result of the battery or cruelty;
(4) The benefits are needed to provide medical care during an un-
wanted pregnancy resulting from the abuser's sexual assault or abuse of,
or relationship with, the alien or his or her child, and/or to care for any
resulting children; or
(5) The medical coverage and/or health care services are needed to re-
place medical coverage or health care services the applicant or child had
when living with the abuser.
(d) For purposes of this section, "nonimmigrant" is defined the same
as in Section 1101(a)(15) of the INA (8 USC section 1101(a)(15)).
(e) For purposes of establishing eligibility for state-only funded long-
term care services described in subdivision (f) of Section 1 of Chapter
1441 of the Statutes of 1 988, all of the following requirements must be
met:
( 1 ) The alien must declare himself or herself to be a qualified alien un-
der subsection (b), a nonimmigrant alien under subsection (d), or an alien
paroled into the United States for less than one year under Section
212(d)(5) of the INA (8 USC section 1 182(d)(5)). The alien shall declare
that status through use of the "Supplemental Alienage and Immigration
Status Declaration" MC 13S (12/96).
(2) The alien must present documents issued by or acceptable to the
Immigrafion and Naturalization Service (INS) which serve as reasonable
evidence of the alien's declared status.
(3) The alien must complete and sign Form MC 13S (12/96).
(4) The documentation presented by the alien as reasonable evidence
of the alien's declared immigration status must be submitted to the INS
for verification through the Systemafic Ahen Verification for Entitle-
ments (SAVE) system procedures as follows:
(A) A primary SAVE system verificadon must be used to access the
biographical/immigration status computer record contained in the Alien
Status Verificafion Index maintained by the INS. Subject to subpara-
graph (B), this procedure must be used to verify the status of all aliens
who claim to be qualified aliens and who present an INS-issued docu-
ment that contains an alien registrafion or alien admission number.
(B) The secondary SAVE system verification procedure must be used
to forward copies of original INS documents evidencing an alien's status
as a qualified alien, as a nonimmigrant ahen under the INA, or as an alien
paroled into the United States under Secfion 21 2(d)(5) of the INA (8 USC
secfion 1 182(d)(5)), for less than one year in any of the following cases:
1. a primary check of the Alien Status Verificafion Index instructs the
county department to "Insfitute secondary verification."
2. The document presented indicates immigration status but does not
include an alien registration or alien admission number.
3. The Ahen Status Verification Index record includes the alien regis-
tration or admission number on the document presented by the alien but
does not match other information contained in the document.
4. The document is suspected to be counterfeit or to have been altered.
5. The document includes an alien registrafion number in the A60 000
000 (not yet issued) or A80 000 000 (illegal border crossing) series.
6. The document is a fee receipt from INS for replacement of a lost,
stolen or unreadable INS document.
7. The document is one of the following: an INS Form 1-18 lb nofifica-
tion letter issued in connecfion with an INS Form 1-181 Memorandum
of Creation of Record of Permanent Residence, an Arrival-Departure
Record (INS Form 1-94) or a foreign passport stamped "PROCESSED
FOR 1-551 , TEMPORARY EVIDENCE OF LAWFUL PERMANENT
RESIDENCE" that INS issued more than one year before the date of
application for Medi-Cal.
(5) Verification of the alien's declared status must be received from
the INS before eligibility for state-only funded long-term care services
is established.
(f) A nonprofit charitable organizafion that provides federal, state, or
local public benefits shall not be required to determine, verify, or other-
wise require proof of eUgibility of any applicant or beneficiary with re-
spect to his or her immigration status or alienage.
(g) Nothing in this section shall be construed to withdraw eligibility
for state public health assistance for immunizations with respect to im-
munizable diseases and for testing and treatment of symptoms of com-
municable diseases whether or not such symptoms are caused by a com-
municable disease.
(h) An alien who is a quahfied alien pursuant to paragraphs (8), (9) or
(10) of subsecfion (b), will remain eligible for Medi-Cal benefits as long
as the need for benefits related to the battery or cruelty is necessary as de-
termined by the county welfare department, and the alien confinues to
meet all Medi-Cal program eligibility requirements. The county eligibil-
ity worker shall review the alien's circumstances to evaluate the benefi-
Page 346
Register 99, No. 41; 10-8-99
Title 22
Health Care Services
§ 50310
•
•
ciary's continued need for Medi-Cal benefits at the annual redetermina-
tion.
(i)(l) Any alien who was made eligible for state-only tiinded long-
term care services for the month in which this section becomes effective
and whose services are terminated, suspended, or reduced, pursuant to
subsection (a), is entitled to a hearing, pursuant to Welfare and Institu-
tions Code Section 10950 and Title 22, California Code of Regulations,
Section 50951, on the issue of whether the alien is a qualified alien as de-
fined under subsection (b), a nonimmigrant alien as defined under sub-
section (d), or an alien paroled into the United States for less than one year
under Section 212(d)(5) of the INA or on the issue of whether a service
requested by the alien falls within one of the exceptions provided in 8
use section 1621(b).
(2) Subject to the provisions of Welfare and Institutions Code Section
10950 and Title 22, California Code of Regulations, Section 50951, any
alien whose application for Medi-Cal benefits is denied for any reason,
including the provisions of subsection (a), is entitled to a hearing.
NOTE: Authority cited: Sections 10723 and 14124.5, Welfare and Institutions
Code. Reference: 8 USC Sections 1 101, 161 1, 1621, 1641 and 1642; Sections 501
and 508 of Division C (the "Immigration Reform and Immigrant Responsibility
Act of 1996") of the Omnibus Consolidated Appropriations Act, 1997 (Pub.L.
104-208); Sections 5302, 5562, 5571 and 5581 of the Balanced Budget Act of
1997 (Pub.L. 105-33) as amended by Sections 401 and 403 of the Taxpayer Relief
Act of 1997 (Pub.L. 105-34.); Sections 14007.5 and 14011, Welfare and Institu-
tions Code; and Section 1, Chapter 1441, Statutes of 1988.
History
1. New section filed 3-4-98; operative 9-4-98 (Register 98, No. 10).
§ 50303. Alien Status Verification.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; and Section 9, Chapter 1441 , Statutes of 1988. Reference: Section 14007.5,
Welfare and Institutions Code; and Sections 1, 2 and 3, Chapter 1441, Statutes of
1988.
History
1 . Repealer and new section filed 10-20-88 as an emergency; operative 10-20-88
(Register 88, No. 45). A Certificate of Compliance must be transmitted to OAL
within 120 days or emergency language will be repealed on 2-20-89.
2. Repealer and new section refiled 2-10-89 as an emergency; operative 2-15-89
(Register 89, No. 8). A Certificate of Compliance must be transmitted to OAL
within 120 days or emergency language will be repealed on 6-1 5-89.
3. Repealer and new section refiled 6-5-89 as an emergency; operative 6-15-89
(Register 89, No. 23). A Certificate of Compliance must be transmitted to OAL
within 120 days or emergency language will be repealed on 10-13-89.
4. Certificate of Compliance transmitted to OAL 10-12-89 and disapproved by
OAL on 1 1-13-89 (Register 89, No. 48).
5. Repealer filed 1 1 -14-89 as an emergency pursuant to section 9 of chapter 1441
of the Statutes of 1 988; operative 1 1-14-89 (Register 89, No. 48). A Certificate
of Compliance must be transmitted to OAL within 1 20 days or emergency lan-
guage will be repealed on 3-14-90.
6. Repealer refiled 3-8-90 as an emergency pursuant to section 9 of chapter 1441
of the Statutes of 1988; operative 3-13-90 (Register 90, No. 12). A Certificate
of Compliance must be transmitted to OAL within 120 days or emergency lan-
guage will be repealed on 7-1 1-90.
7. Certificate of Compliance as to 3-8-90 order transmitted to OAL 7-5-90 and
disapproved 8-6-90 (Register 90, No. 42).
8. Repealer filed 8-23-90 as an emergency pursuant to section 9 of chapter 1441
of the Statutes of 1988; operative 8-23-90 (Register 90, No. 42). A Certificate
of Compliance must be transmitted to OAL by 12-21-90 or emergency lan-
guage will be repealed by operation of law on the following day.
9. Certificate of Compliance as to 8-23-90 order transmitted to OAL 11-20-90
and filed 12-17-90 (Register 91, No. 5).
10. Editorial conection of printing error in HISTORY 8. (Register 91, No. 32).
§ 50304. Written Declaration of Status as a Citizen of tlie
United States, a National of the United States,
or an Alien.
(a) Individuals requesting or receiving Medi-Cal benefits shall state
in writing, under penalty of perjury, whether they are citizens or nationals
of the United States or aliens. In the case of a child under 21 years of age,
the child's parent, caretaker relafive, or legal guardian shall attest to this
fact on the child's behalf unless the child is considered an adult for Medi-
Cal purposes in accordance with secfions 50014 and 50030(a).
NOTE; Authority cited: Sections 10725 and 14124.5, Welfare and Insfitutions
Code; and Section 9, Chapter 1441 , Statutes of 1988. Reference: Secfions 14007.5
and 1401 1, Welfare and Institufions Code.
History
1. Repealer filed 10-20-88 as an emergency; operative 10-20-88 (Register 88,
No. 45). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed and former section reinstated as
it existed prior to emergency repeal on 2-20-89.
2. Repealer refiled 2-10-89 as an emergency; operative 2-15-89 (Register 89,
No. 8). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 6-1 5-89.
3. Repealer refiled 6-5-89 as an emergency; operative 6-1 5-89 (Register 89, No.
23). A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on 10-13-89.
4. Certificate of Compliance transmitted to OAL 10-12-89 and disapproved by
OAL on 1 1-1 3-89 (Register 89, No. 48).
5. Repealer and new section filed 1 1-14-89 as an emergency pursuant to section
9 of chapter 1441 of the Statutes of 1988; operative 1 1-14-89 (Register 89, No.
48). A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on 3-14-90.
6. Repealer and new section refiled 3-8-90 as an emergency pursuant to section
9of chapter 1441 of the Statutes of 1988; operative 3-1 3-90 (Register 90, No.
12). A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on 7-1 1-90.
7. Certificate of Compliance as to 3-8-90 order transmitted to OAL 7-5-90 and
disapproved 8-6-90 (Register 90, No. 42).
8. Repealer and new section filed 8-23-90 as an emergency pursuant to section
9 of chapter 1441 of the Statutes of 1988; operafive 8-23-90 (Register 90, No.
42). A Certificate of Compliance must be transmitted to OAL by 12-21-90 or
emergency language will be repealed by operation of law on the following day.
9. Certificate of Compliance as to 8-23-90 order transmitted to OAL 1 1-20-90
and filed 12-17-90 (Register 91, No. 5).
§ 50305. Documentation of an Alien's Legal Status.
History
1. Repealer filed 10-20-88 as an emergency; operative 10-20-88 (Register 88,
No. 45). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed and former section reinstated as
it existed prior to emergency repeal on 2-20-89.
2. Repealer refiled 2-10-89 as an emergency; operative 2-15-89 (Register 89,
No. 8). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 6-15-89.
3. Repealer refiled 6-5-89 as an emergency; operafive 6-1 5-89 (Register 89, No.
23). A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on 10-13-89.
4. Certificate of Compliance transmitted to OAL 10-12-89 and disapproved by
OAL on 11-13-89 (Register 89, No. 48).
5. Repealer filed 1 1-14-89 as an emergency pursuant to secfion 9 of chapter 1441
of the Statutes of 1988; operative 1 1-14-89 (Register 89, No. 48). A Certificate
of Compliance must be transmitted to OAL within 120 days or emergency lan-
guage will be repealed on 3-14-90.
6. Repealer refiled 3-8-90 as an emergency pursuant to section 9 of chapter 1441
of the Statutes of 1988; operafive 3-13-90 (Register 90, No. 12). A Certificate
of Compliance must be transmitted to OAL within 1 20 days or emergency lan-
guage will be repealed on 7-11-90.
7. Certificate of Compliance as to 3-8-90 order U-ansmitted to OAL 7-5-90 and
disapproved 8-6-90 (Register 90, No. 42).
8. Repealer filed 8-23-90 as an emergency pursuant to section 9 of chapter 1441
of the Statutes of 1988; operative 8-23-90 (Register 90, No. 42). A Certificate
of Compliance must be transmitted to OAL by 12-21-90 or emergency lan-
guage will be repealed by operation of law on the following day.
9. Certificate of Compliance as to 8-23-90 order transmitted to OAL 1 1-20-90
and filed 12-17-90 (Register 91, No. 5).
§50310. WR 6 Procedure.
History
1. Repealer filed 10-20-88 as an emergency; operative 10-20-88 (Register 88,
No. 45). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed and former section reinstated as
it existed prior to emergency repeal on 2-20-89.
2. Repealer refiled 2-10-89 as an emergency; operative 2-15-89 (Register 89,
No. 8). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 6-15-89.
3. Repealer refiled 6-5-89 as an emergency; operafive 6-15-89 (Register 89, No.
23). A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on 10-13-89.
4. Certificate of Compliance transmitted to OAL 10-12-89 and disapproved by
OAL on 1 ]-] 3-89 (Register 89, No. 48).
5. Repealer filed 1 1-14-89 as an emergency pursuant to secfion 9 of chapter 1441
of the Statutes of 1988; operative 11-14-89 (Register 89, No. 48). A Certificate
of Compliance must be transmitted to OAL within 120 days or emergency lan-
guage will be repealed on 3-14-90.
6. Repealer refiled 3-8-90 as an emergency pursuant to section 9 of chapter 1441
of the Statutes of 1988; operafive 3-13-90 (Register 90, No. 12). A Certificate
of Compliance must be transmitted to OAL within 120 days or emergency lan-
guage will be repealed on 7-1 1-90.
7. Certificate of Compliance as to 3-8-90 order transmitted to OAL 7-5-90 and
disapproved 8-6-90 (Register 90, No. 42).
Page 346.1
Register 99, No. 41; 10-8-99
§ 50311
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
8. Repealer filed 8-23-90 as an emeigency pursuant to section 9 of chapter ]44]
of tile Statutes of 1988; operative 8-23-90 (Register 90, No. 42). A Certificate
of Compliance must be transmitted to OAL by 12-21-90 or emergency lan-
guage will be repealed by operation of law on the following day.
9. Certificate of Compliance as to 8-23-90 order transmitted to OAL 1 1-20-90
and filed 12-17-90 (Register 91, No. 5).
§ 5031 1 . Lawful Presence in the United States.
History
1. New subsection (c) filed 12-15-77; effective thirtieth day thereafter (Register
77, No. 51).
2. Repealer filed 10-20-88 as an emergency; operative 10-20-88 (Register 88,
No. 45). A Certificate of Compliance must be transmitted lo OAL within 120
days or emergency language will be repealed and former section reinstated as
it existed prior to emergency repeal on 2-20-89.
3. Repealer refiled 2-10-89 as an emergency; operative 2-15-89 (Register 89,
No. 8). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 6-15-89.
4. Repealer refiled 6-5-89 as an emergency; operative 6-1 5-89 (Register 89, No.
23). A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on lO-l 3-89.
5. Certificate of Compliance transmitted to OAL 10-12-89 and disapproved by
OAL on 11-13-89 (Register 89, No. 48).
6. Repealer filed 11-14-89 as an emergency pursuant to secfion 9 of chapter 1441
ofthe Statutes of 1988; operative 11-14-89 (Register 89, No. 48). A Certificate
of Compliance must be transmitted to OAL within 1 20 days or emergency lan-
guage will be repealed on 3-14-90.
7. Repealer refiled 3-8-90 as an emergency pursuant to section 9 of chapter 1441
ofthe Statutes of 1988; operative 3-1 3-90 (Register 90. No. 12). A Certificate
of Compliance must be transmitted to OAL within 1 20 days or emergency lan-
guage will be repealed on 7-1 1-90.
8. Certificate of Compliance as to 3-8-90 order transmitted to OAL 7-5-90 and
disapproved 8-6-90 (Register 90, No. 42).
9. Repealer filed 8-23-90 as an emergency pursuant to section 9 of chapter 1441
ofthe Statutes of 1988; operative 8-23-90 (Register 90, No. 42). A Certificate
of Compliance must be transmitted to OAL by 12-21-90 or emergency lan-
guage will be repealed by operation of law on the following day.
10. Certificate of Compliance as to 8-23-90 order transmitted to OAL 1 1-20-90
and filed 12-17-90 (Register 91, No. 5).
§ 50313. Legal Entry for a Limited Period.
History
1. Repealer filed 10-20-88 as an emergency; operative 10-20-88 (Register 88,
No. 45). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed and former section reinstated as
it existed prior to emergency repeal on 2-20-89.
2. Repealer refiled 2-10-89 as an emergency; operative 2-15-89 (Register 89,
No. 8). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 6-13-89.
3. Repealer refiled 6-5-89 as an emergency; operative 6-1 5-89 (Register 89, No.
23). A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on 10-13-89.
4. Certificate of Compliance transmitted to OAL 10-12-89 and disapproved by
OAL on 1 1-13-89 (Register 89, No. 48).
5. Repealer filed 1 1-14-89 as an emergency pursuant to section 9 of chapter 1441
ofthe Statutes of 1988; operative 1 1-14-89 (Register 89, No. 48). A Certificate
of Compliance must be transmitted to OAL within 1 20 days or emergency lan-
guage will be repealed on 3-14-90.
6. Repealer refiled 3-8-90 as an emergency pursuant to section 9 of chapter 1441
ofthe Statutes of 1988; operative 3-13-90 (Register 90, No. 12). A Certificate
of Compliance must be transmitted to OAL within 1 20 days or emergency lan-
guage will be repealed on 7-1 1-90.
7. Certificate of Compliance as to 3-8-90 order transmitted to OAL 7-5-90 and
disapproved 8-6-90 (Register 90, No. 42).
8. Repealer filed 8-23-90 as an emergency pursuant to section 9 of chapter 1441
ofthe Statutes of 1988; operative 8-23-90 (Register 90, No. 42). A Certificate
of Compliance must be transmitted to OAL by 12-21-90 or emergency lan-
guage will be repealed by operation of law on the following day.
9. Certificate of Compliance as to 8-23-90 order transmitted to OAL 11-20-90
and filed 12-17-90 (Register 91, No. 5).
§ 50320. California Residence — General.
(a) California residence is a requirement for Medi-Cal eligibility.
(b) California residence shall be established by either ofthe following
if the verification requirements of Section 50320.1 are met:
(1) The applicant is physically present and is living in California with
the intention to remain permanently or for an indefinite period.
(2) The applicant is physically present, is living in California and en-
tered the State with a job commitment or to seek employment, whether
or not currently employed.
(c) Children living with their parents shall have their residence deter-
mined as that of their parents, except that parents who do not meet the
California residency requirements may establish California residence for
their children if both ofthe following circumstances apply. The parents:
(1 ) Intend for their children to remain in Cahfomia on other than a tem-
porary basis.
(2) Have made arrangements for the children to remain in California
independent of the parents.
(d) Family members may establish separate residences without a break
in marital or family ties. Only those family members who meet the re-
quirements of this article shall be eligible for Medi-Cal.
(e) Once California residence is established it continues until resi-
dence is established in another state or country.
(f) A person's declaration on the MC 210 Statement of Facts (Medi-
Cal), or on the SAWS 2 Statement of Facts, together with the evidence
required in Section 50320. 1 , shall be accepted for purposes of establish-
ing residence unless there is evidence to the contrary.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institufions
Code. Reference: Section 66, Chapter 722, Statutes of 1 992 and 42 Code of Feder-
al Regulations 435.403.
History
1. Relettering of subsection (c) to subsection (d) and new subsection (c) filed
2-6-80 as an emergency; effective upon filing. A Certificate of Compliance
must be transmitted to OAH within 1 20 days or emergency language will be re-
pealed on 6-6-80. (Register 80, No. 6).
2. Certificate of Compliance filed 6-6-80 (Register 80, No. 23).
3. Amendment filed 10-23-81; effective thirtieth day thereafter (Register 81, No.
43).
4. Amendment of subsection (b)-(b)(2), (e), (f) and Note filed 5-17-93 as an
emergency with Secretary of State by the Department of Health Services; opera-
tive 5-17-93. Submitted to OAL for printing only pursuant to 1992 Senate Bill
485(Register93, No. 21).
§ 50320.1. California Residence — Evidence.
(a) In addition to the declaration of residence on the MC 210 State-
ments of Facts (Medi-Cal), or on the SAWS 2 Statement of Facts, Cali-
fornia residence is not established unless both ofthe following conditions
are met as required in Subdivision 50230(f):
(1) The applicant produces one of the following:
(A) A current California rent or mortgage receipt or utility bill in the
applicant's name bearing the current address of the applicant. Rent re-
ceipts provided by a relative shall not be accepted for purfioses of Section
50320.1(a)(1) in the absence of other credible evidence that supports a
finding that the applicant is a resident of California pursuant to Section
50320(b) unless the relative declares under penalty of perjury that the in-
formation set forth on the rent receipt provided by the apphcant is true
and correct.
(B) A current and valid California motor vehicle driver's license or
California Identification Card issued by the California Department of
Motor Vehicles in the applicant' s name bearing the current address ofthe
applicant.
(C) A current and valid California motor vehicle registration in the
applicant's name bearing the current address ofthe applicant.
(D) A document showing that the applicant is employed in this state.
(E) A document showing that the applicant has registered with a public
or private employment service in this state.
(F) Evidence that the applicant has enrolled his or her children in a
school in this state.
(G) Evidence that the applicant is receiving public assistance other
than Medi-Cal in this state.
(H) Evidence that the applicant has registered to vote in this state.
(1) Any evidence produced in accordance with subdivision b.
(2) The applicant declares under penalty of perjury, that all ofthe fol-
lowing apply:
(A) The applicant does not maintain a principal residence outside this
state. When an applicant is unable to make this declaration because he or
Page 346.2
Register 99, No. 41; 10-8-99
Title 22 Health Care Services § 50320.1
she claims an out-of-state principal residence as exempt property under ment insurance benefits.
section 50425, the county shall consider any evidence provided by the (b) If an applicant, including but not limited to homeless persons and
applicant pursuant to Section 50320.2(c). migrant workers, declares under penalty of perjury, that he or she does
(B) The applicant is not receiving public assistance outside this state, not have one of the residency verification documents required in Subdi-
As used in the section, "public assistance" does not include unemploy- vision (a)(1)(A) through (a)(1)(H), the county shall consider, pursuant to
[The next page is 347.]
Page 346.3 Register 99, No. 41; 10-8-99
Title 22
Health Care Services
§ 50329
Section 50320.2, any other evidence produced by an applicant to verify
residency except those documents specified in subdivision 50320.2(b).
NOTE: Authority cited: Sections 10725, 14007.1 and 14124.5, Welfare and Insti-
tutions Code. Reference: Section 66, Chapter 722, Statutes of 1992; and 42 Code
of Federal Regulations 435.403.
History
1 . New section filed 5-1 7-93 as an emergency with Secretary of State by the De-
partment of Health Services; operative 5-17-93. Submitted to OAL for printing
only pursuant to 1992 Senate Bill 485 (Register 93, No. 21).
§ 50320.2. California Residency — County Verification.
(a) The county may request clarification of the applicant's residency
if it determines that any information provided as part of his or her Medi-
Cal application is inconsistent with the statement on the MC 210 State-
ment of Facts (Medi-Cal), or on the SAWS 2 Statement of Facts that the
applicant is a resident of California.
(b) A declaration, affidavit, or other statement from the applicant, or
any other person that the applicant is a resident of California is unaccept-
able as verification of residency in the absence of other credible evidence
that supports a finding that the applicant is a resident of California pur-
suant to Section 50320(b).
(c) When an applicant claims an out-of-state principal residence as
exempt property under Section 50425, the county shall determine that
such an applicant is a resident of California only if a preponderance of
the credible evidence provided under Section 50320.1 supports a finding
that the applicant is a resident of California pursuant to Section 50320(b).
(d) A migrant worker who claims to be a resident of California pur-
suant to Section 50320(b)(2) shall provide evidence that he or she entered
the state with a job commitment or evidence that he or she entered the
state to seek employment, whether or not currently employed. The
county shall determine that such an applicant is a resident of CaUfornia
only if a preponderance of the credible evidence supports a finding that
the applicant is a resident of California pursuant to Section 50320(b)(2).
(e) The county may determine that the claim on the MC 210 Statement
of Facts (Medi-Cal), or on the SAWS 2 Statement of Facts is supported,
and that the applicant is a resident of California if a preponderance of the
credible evidence produced by the applicant supports a finding that the
applicant is a resident of California. If a preponderance of the credible
evidence produced by the applicant does not support the finding that the
applicant is a resident of California, the applicant shall be determined not
to be a resident of California, shall be denied eligibility for Medi-Cal
benefits, and shall be afforded all notification and fair hearing rights pro-
vided to any person denied eligibility for Medi-Cal.
(f) A denial of a determination of residency may be appealed in the
same manner as any other denial of eligibility. The Administrative Law
Judge shall receive any proof of residency offered by the applicant and
may inquire into any facts relevant to the question of residency. A deter-
mination of residency shall not be granted unless a preponderance of the
credible evidence supports either the applicant's intent to remain indefi-
nitely in this state, or any other basis provided by the laws governing the
Medi-Cal program for establishing residency for Medi-Cal eligibiUty.
NOTE: Authority cited: Sections 10725, 14007.1 and 14124.5, Welfare and Insti-
tutions Code. Reference: Section 66, Chapter 722, Statutes of 1992; and 42 Code
of Federal Regulations 435.403.
History
1 . New section filed 5-17-93 as an emergency with Secretary of State by the De-
partment of Health Services; operative 5-17-93. Submitted to OAL for printing
only pursuant to 1992 Senate Bill 485 (Register 93, No. 21).
§ 50321 . Temporary Absence from the State.
(a) Residence shall not be affected by temporary absence from the
State for periods of 60 days or less. An absence of 60 days or less shall
be presumed to be a temporary absence unless there is evidence to the
contrary.
(b) An apphcation, restoration, redetermination or reapplication from
an applicant or beneficiary who is temporarily absent from the State for
60 days or less shall be accepted.
Note: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: 42 Code of Federal Regulations 435.403.
History
1 . New Note filed 5- 1 7-93 as an emergency with Secretary of State by the Depart-
ment of Health Services; operative 5-17-93. Submitted to OAL for printing
only pursuant to 1992 Senate Bill 485 (Register 93, No. 21).
§ 50323. Absence from the State for More Than 60 Days.
(a) Absence from the State for more than 60 days shall be presumptive
evidence of the applicant's or beneficiary's intent to change residence
from California to a place outside the State unless the person declares in
writing both:
(1) An intent to return to California.
(2) The existence of one of the following circumstances:
(A) Illness or emergency circumstances which prohibit return to Cali-
fornia.
(B) Family members with whom the applicant or beneficiary lives are
California residents and are physically present in the State.
(C) The applicant or beneficiary maintains California housing ar-
rangements.
(b) Unless there is evidence to the contrary, California residence may
be considered to be terminated when an applicant or beneficiary leaves
California and then takes any of the following actions in another state:
(1) Purchases, leases or rents a residence.
(2) Becomes employed.
(3) Obtains an out-of-state driver's license.
(4) Applies for aid in another state.
(c) Medi-Cal shall be discontinued effective the last day of the month
in which residence terminated, if the 10 day notice can be given. Other-
wise, the discontinuance shall be effective the last day of the following
month.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: 42 Code of Federal Regulations 435.403.
History
1. Amendment of subsection (a) and new Note filed 5-17-93 as an emergency
with Secretary of State by the Department of Health Services; operative
5-17-93. Submitted to OAL for printing onlv pursuant to 1992 Senate Bill 485
(Register93, No. 21).
§ 50325. Death During Absence from the State.
A person who dies during an absence from the State shall be consid-
ered a resident if there is evidence that the requirements of Section 50321
or Section 50323 were met at the time of death.
NoTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: 42 Code of Federal Regulations 435.403.
History
1 . New Note filed 5-17-93 as an emergency with Secretary of State by the Depart-
ment of Health Services; operative 5-17-93. Submitted to OAL for printing
only pursuant to 1992 Senate Bill 485 (Register 93, No. 21).
§ 50327. Persons Living on Land Leased or Owned by the
United States.
Persons living within the boundaries of California on land owned or
leased by the Federal Government shall be considered California resi-
dents.
NotE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: 42 Code of Federal Regulations 435.403.
History
1 . New Note filed 5-1 7-93 as an emergency with Secretary of State by the Depart-
ment of Health Services; operative 5-17-93. Submitted to OAL for printing
only pursuant to 1992 Senate Bill 485 (Register 93, No. 21 ).
§ 50329. Persons on Parole from Correctional or Other
Institutions.
Persons on parole from correctional or other institutions may establish
California residence.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: 42 Code of Federal Regulafions 435.403.
History
1 . New Note filed 5-17-93 as an emergency with Secretary of State by the Depart-
ment of Health Services; operative 5-17-93. Submitted to OAL for printing
only pursuant to 1992 Senate Bill 485 (Register 93, No. 21 ).
Page 347
Register 97, No. 50; 12-12-97
§ 50331
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
§ 50331 . United States Citizen Children of Aliens.
NOTE; Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14007, Welfare and Institutions Code.
History
1 . Repealer filed 2-6-80 as an emergency; effective upon filing. A Certificate of
Compliance must be transmitted to OAH within 120 days or emergency lan-
guage will be repealed on 6-6-80 (Register 80, No. 6).
2. Certificate of Compliance filed 6-6-80 (Register 80, No. 23).
§ 50333. Foster Children and Institutionalized Persons
Placed Out-of-state.
(a) A child placed in out-of-state foster care maintains California resi-
dence if the child was placed under either of the following:
(1) Through the Interstate Compact on the Placement of Children.
(2) By a state or county agency responsible for the child's care.
(b) A person placed in an out-of-state institution by a state or county
agency responsible for the person's care maintains California residence
unless the other state accepts responsibility for the person.
NOTE; Authority cited: Secfions 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14007, Welfare and Institutions Code.
History
1 . Amendment filed 10-23-81 ; effective thirtieth day thereafter (Register 81 , No.
43).
§ 50334. Out-of-state Foster Children and
Institutionalized Persons Placed in California.
(a) An out-of-state child placed in foster care in California is a Cali-
fornia resident if both of the following conditions are met:
(1) The child was placed by an out-of-state court directly with a
guardian or foster parent in California.
(2) The other state has not adopted the Interstate Compact on the Place-
ment of Children.
(b) An out-of-state person placed in an institution in California by
another state agency, or a local goveinment agency in another state, re-
sponsible for the person's care remains a resident of the placing state un-
less a California state or county agency accepts responsibility for the per-
son.
NOTE; Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14007, Welfare and InsUtutions Code.
History
1 . Amendment filed 10-23-81 ; effective thirtieth day thereafter (Register 81, No.
43).
§ 50336. Other Persons in Out-of-State Institutions.
(a) The Director shall have the authority to determine the state of resi-
dence for a person who is living in an institution in another state when
that state's medical assistance agency claims the person is a California
resident.
(b) Applications for Medi-Cal on behalf of the persons specified in (a)
shall be referred to the Director by the county department.
(c) The determination shall be made in accordance with federal Medic-
aid regulation 42 CFR 435.403, and shall be based upon such factors as
the person's age, competency, former state of physical presence, the resi-
dence of the person's parents or in accordance with an interstate agree-
ment entered into by the Director and another state's medical assistance
agency.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and InsUtutions
Code. Reference: Section 14007, Welfare and Institutions Code.
History
1. New section filed 10-23-81; effective thirtieth day thereafter (Register 81, No.
43).
2. Amendment of subsection (c) filed 5-17-93 as an emergency with Secretary of
State by the Department of Health Services; operative 5-17-93. Submitted to
OAL for printing only pursuant to 1992 Senate Bill 485 (Register 93, No. 21).
§ 50338. Other Persons in California Institutions.
(a) Persons living in California institutions, other than persons speci-
fied in Section 50334 shall be considered California residents.
(b) Notwithstanding (a), the Director shall have the authority to deter-
mine the state of residence for persons in California institutions in accor-
dance with federal Medicaid regulation 42 CFR 435.403. The determina-
tion shall be based upon such factors as the person's age, competency,
fonner state of physical presence and the residence of llie person's par-
ents, or in accordance with an interstate agreeinent entered into by the Di-
rector and another state's medical assistance agency. The county depart-
ment shall, upon request by the Director, obtain the information
necessary for the determination to be made.
NOTE; Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14007, Welfare and InsUtutions Code.
History
1. New section filed 10-23-81; effective thirtieth day thereafter (Register 8 1, No.
43).
2. Amendment of subsection (b) filed 5-17-93 as an emergency with Secretary of
State by the Department of Health Services; operative 5-17-93. Submitted to
OAL for printing only pursuant to 1992 Senate Bill 485 (Register 93, No. 21).
Article 8.
Responsible Relatives and Unit
Determination
§ 50351 . Responsible Relatives.
(a) The responsibility of a relative to contribute to the cost of health
care services of a Medi-Cal applicant or beneficiary shall be limited to
spouse for spouse and parent for child.
(b) In determining Medi-Cal eligibility and share of cost, relative re-
sponsibility shall be determined in accordance with the following:
(1 ) Relative responsibility shall be spouse for spouse when the spouses
are living together in the home.
(2) If one or both of the spouses is in LTC or board and care, the
spouses income and property shall be considered available in determin-
ing each other's eligibility and share of cost in accordance with the
MFBU composition provision of Section 50377.
(3) If neither of the spouses is in LTC or board and care but the spouses
are living apart, the spouses shall have their eligibility and share of cost
determined as single persons the day following the separation, if it is
known that the separation will not be temporary in accordance with Sec-
tion 50071(b).
(4) Relative responsibility shall be parent for child living in the par-
ent's home and persons specified in (c), except that the parents shall nei-
ther be held financially responsible for, nor asked or required to contrib-
ute to, or provide other health care coverage for, the cost of minor consent
services which the child applies for in accordance with Section
50147.1(a).
(c) Notwithstanding Sections 50014 and 50030, any person whether
h ving in the home or away from the home, shall be considered a child and
his/her parent shall be considered a responsible relative when both of the
following conditions exist:
(1) The person is 18 years of age or older but under 21.
(2) The parent claims the child as a dependent in order to receive a tax
credit or deduction for state or federal income tax purposes.
(d) Where, under Section 50373(a)(5), deeming occurs that is not
spouse for spouse or parent for child as required under subsection (a), and
the family has excess properly or a share of cost, or both, the county shall
redetermine the budget unit to ensure that each person's available income
is deemed only to that person's child or spouse. For the purposes of this
subsection, "deeming" is the process by which the income of one person
is treated as available to another person.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; and Section 87(c), Chapter 1594, Statutes of 1982. Reference: Sections
14008, 14008.6 and 14010, Welfare and Insntutions Code; and Sections 25.9 and
34.7, Civil Code; and 42 C.F.R. Sections 433.135, 433.136, 433.137, 433.138,
433.145, 433.146, 433.147, 433.148 and 435.604; and Sneed v. AT/zer (N.D. Cal
1990)728F. Supp. 607.
History
1 . Amendment filed 1-28-77 as an emergency; effective upon filing (Register 77,
No. 5).
2. Certificate of Compliance filed 4-22-77 (Register 77, No. 17).
3. Amendment of subsections (a)(2)(C) and (b), and repealer of subsection (d) filed
10-31-78 as an emergency; designated effective 11-1-78 (Register 78, No.
44).
Page 348
Register 97, No. 50; 12-12-97
Title 22
Health Care Services
§ 50373
•
4. Certificate of Compliance filed 2-6-78 (Register 79, No. 6).
5. Amendment filed l-8-81;effectivethirtiethday thereafter (Register 81, No. 2).
6. Amendment of subsection (b)(4) filed 4-28-82; effective thirtieth day thereaf-
ter (Register 82, No. 1 8).
7. Amendment filed 10-1-82 as an emergency; effective upon filing (Register 82,
No. 40). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 1-29-83.
8. Certificate of Compliance transmitted to OAL 1-28-83 and filed 2-28-83
(Register 83, No. 10).
9. Amendment of subsection (c)( 1 ) filed 12-3-85; effective thirtieth day thereafter
(Register 85, No. 49).
10. Amendment of subsecfion (b)(2) and Note and repealer of subsection (d) filed
4-16-93 as an emergency; operative 4-16-93 (Register 93, No. 16). A Certifi-
cate of Compliance must be transmitted to OAL 8-16-93 or emergency lan-
guage will be repealed by operation of law on the following day.
1 1 . Certificate of Compliance as to 4-1 6-93 order includins amendment of Note
transmitted to OAL 8-13-93 and filed 9-23-93 (Register 93, No. 39).
12. New subsection (d) and amendment of Note filed 12-9-97; operafive 1-8-98
(Register 97, No. 50).
§ 50371 . Medi-Cal Family Budget Unit.
(a) The Medi-Cal Family Budget Unit (MFBU) shall be the basic unit
of persons considered in determining a person's or family's eligibility
and share of cost. The MFBU shall be established in accordance with
Sections 50373 through 50379. Members of the MFBU may be excluded
from an established MFBU in accordance with Section 50381.
(b) Changes in the MFBU shall be reflected in the share of cost deter-
mination within the time frames specified in Section 50565, except that
the changes may be reflected in the month the changes are reported if it
is to the beneficiary's advantage. Any advantage shall be explained to the
beneficiary. The beneficiary shall determine whether the change shall be
reflected in the month it is reported.
Note-. Authority cited; Sections 10725 and 14124.5. Welfare and Institutions
Code.Reference:Sectionsl4005.5, 14005.7, 14008 and 14051, Welfare and Insti-
tutions Code.
History
1. Amendment filed 1-28-77 as an emergency; effecfive upon filing (Register 77,
No. 5).
2. Certificate of Compliance filed 4-22-77 (Register 77, No. 17).
3. Amendment of subsections (e) and (f) and repealer of subsection (i) filed
12-1 5-77; effecfive thirtieth day thereafter (Register 77, No. 51).
4. Amendment filed 3-7-80; effective thirtieth day thereafter (Register 80, No. 9).
5. Amendment filed 1 -8-81 ; effective thirtieth day thereafter (Register 81 , No. 2).
6. Amendment of subsection (a) filed 4-17-89; operative 5-17-89 (Resister 89,
No. 48).
§ 50373. Medi-Cal Family Budget Unit Determination, No
Family Member in LTC or Board and Care.
(a) The MFBU for a family with no family member in LTC or board
and care shall be determined in accordance with the following:
(1) Family members who are PA or Other PA recipients, except for
persons eligible for four month or nine month continuing eligibility, shall
not be included in the MFBU.
(2) All family members living in the home, other than those specified
in (1), shall be included in the MFBU in accordance with (5) whether or
not they are eligible for, or wish to receive, Medi-Cal. Potential members
of the MFBU may be excluded in accordance with Section 50381.
(3) All family members living in the home, except those children ex-
cluded from the MFBU in accordance with 50381 and children who are
ineligible for Medi-Cal, shall be considered in determining whether link-
age to AFDC exists. Family members also include persons who are PA
or other PA recipients.
(4) A person who is 18 years of age or older, but under age 21, is
claimed as a dependent in order to receive a tax credit or deduction for
state or federal income tax purposes shall be included in his/her parent's
MFBU.
(5) Once the potential members of the MFBU have been identified, the
MFBU shall be determined in accordance with the following as modified
by Section 50374;
Page 349
Register 97, No. 50; 12-12-97
§ 50373
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
(A) Family members living in
the home.
1. Individual adult.
2. Individual, spouse.
3. Parent, children.
4. Both unmarried parents, mu-
tual children.
5. Both unmarried parents, mu-
tual children, separate children of
either or both parents.
6. Parent, spouse, mutual chil-
dren.
7. Parent, spouse, mutual chil-
dren and/or separate child of either
or both parents.
8. Minor parent, minor parent's
children, the minor parent's parent
and that person's spouse and/or
children.
9. Unmarried minor parent, sec-
ond unmarried parent, their mutual
children, separate children of either
or both, unmarried minor parent's
parent and that person's spouse
and/or children.
10. Married minor parent, minor
parent's spouse, their mutual chil-
dren, separate children of either or
both, minor parent' s parent and that
person's spouse and/or children.
(B) MFBU
1. Individual adult.
2. Individual, spouse.
3. Parent, children.
4. Both unmarried parents,
mutual children.
5. Both unmarried parents,
mutual children, separate
children, except that when all
the mutual children are ex-
cluded in accordance with
Section 50381, each unmar-
ried parent and that parent's
separate children shall be in a
separate MFBU.
6. Parent, spouse, mutual
children.
7. Parent, spouse, mutual
cMldren, separate children or
the parent and the separate
children of that parent if the
conditions of 50375 are met.
8. Two MFBU' s:
a. Minor parent as an ineli-
gible member, minor parent's
children.
b. Minor parent, the minor
parent's parent and that per-
son's spouse and/or children
(MFBU is determined in ac-
cordance with (3) through
(7)).
Q.TwoMFBU's:
a. Unmarried minor parent
as an ineligible member, sec-
ond unmarried parent, sepa-
rate children of either unmar-
ried parents, mutual children.
b. Unmarried minor parent,
the unmarried minor parent's,
parent(s) and his/her spouse
and/or children (MFBU is de-
termined in accordance with
(3) through (7)).
10. Three MFBU' s:
a. Married minor parent;
married minor parent' s spouse
and children as ineligible
members, and married minor
parent's parent and that per-
son's spouse as ineligible
member(s).
b. Married minor parent as
an ineligible member, married
child's spouse and children.
c. Married minor parent as
an ineligible member, married
minor's parent and that per-
son's spouse and/or children.
1 1 . Child living with the child's
parents requesting Medi-Cal for
minor consent services, whose
application is being processed in
accordance with Section
501 47. 1 (d) (3) (D), the child's chil-
dren.
12. Sibling children if all other
family members are PA or Other
PA.
13. Parent, spouse if all children
are PA or other PA.
14. Sibling children, caretaker
relative.
15. Caretaker relative if all chil-
dren are PA or other PA.
16. Sibhng children, caretaker
relative, caretaker relative's spouse
and/or children.
17. Caretaker; sibhng children;
caretaker's spouse. (Spouse does
not want Medi-Cal or is not eligi-
ble).
18. Caretaker; sibling children;
caretaker's spouse; their own
children. (Spouse has no linkage.
Caretaker has linkage only as a
caretaker relative.
19. Caretaker; sibling children;
other related sibling children.
11. Child
children.
and the child's
20. Caretaker; sibling children;
caretaker's spouse is PA. (Care-
taker has linkage only as a care-
taker relative).
21. Caretaker; sibling children
are PA; caretaker's spouse; their
own children. (Caretaker has link-
age only as a caretaker relative or
chooses to be linked to related
children other than his/her own).
22. Caretaker; sibling children;
caretaker's spouse is PA; their
own children. (Caretaker has Unk-
age only as a caretaker relative or
chooses to be linked to related
children other that his/her own).
12. Sibling children.
13. Parent, spouse.
14. Sibling children and care-
taker relative, when the caretak-
er relative chooses to be in-
cluded.
15. Caretaker relative.
16. Two MFBU' s:
a. Sibhng children.
b. Caretaker relative and his/
her spouse and/or children
(MFBU is determined in accor-
dance with (3) through (7)).
17. Caretaker; sibling chil-
dren.
18. TwoMFBU's:
a. Caretaker; sibling children.
b. Caretaker and caretaker's
spouse as ineligible; their
own children.
19. TwoMFBU's:
a. Sibling children.
(Caretaker has linkage only as
a caretaker relative).
b. Other sibling children;
Caretaker
or
c. Sibling children; caretaker,
d. Other sibling children.
20. Caretaker; sibling children.
21. TwoMFBU's:
a. Caretaker.
b. Caretaker as ineligible;
spouse; his/her own children.
22. Two MFBU's:
a. Caretaker; sibhng chil-
dren.
b. Caretaker as ineligible
member; his/her own children.
Page 350
Register 97, No. 50; 12-12-97
Title 22
Health Care Services
§ 50375
•
(C) Family members, not liv-
ing in the home.
1. Person 18 to 21 when the
person is claimed by his/her par-
ent(s) as a dependent in order to
receive a tax credit or deduction
for state or federal income taxa-
tion.
2. Person 18 to 21, person's
spouse and children, and person's
parent(s) when the person is
claimed by his/her parent(s) as a
dependent in order to receive a tax
credit or deduction for state or
federal income taxation.
3. Child in foster care.
4. Sibling children in foster
care.
(D) MFBU
1 . Person and parents in ac-
cordance with (A).
2. Three MFBU' s.
a. Person claimed as a tax
dependent; person's spouse
and children as ineligible
members, and person's par-
ent(s) as ineligible mem-
bers(s).
b. Person claimed as a tax
dependent as an ineligible
member, person's spouse and
children.
c. Person claimed as a tax
dependent as an ineligible
member, person's parent(s).
3. Child.
4. Each sibling child is in
his/her own MFBU even if
placed in the same foster
home.
5. Child.
•
5. Child detained or place by a
court or court designated agency
under Welfare and Institutions
Code Sections 300 or 601. 6. Child.
6. Child not living with a parent
or relative for whom a pubhc
agency is assuming financial re-
sponsibility in whole or in part. 7. Child.
7. Child not living with a parent
or caretaker relative when parents
or public agencies have been con-
tacted to determine whether they
will accept legal responsibility for
the child.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4, 14005.7, 14005.8, 14008 and 14010, Welfare
and Institutions Code.
History
1. Amendment of subsections (a)(1) and (a) (4) filed 4-15-83 as an emergency;
effective upon filing (Register 85, No. 16). A Certificate of Compliance must
be transmitted to OAL within 120 days or emergency language will be repealed
on 8-1 3-85. For prior history, see Register 83, No. 21 .
2. Certificate of Compliance transmitted to OAL, 8-13-85 and filed 9-18-85
(Register 85, No. 38).
3. Amendment of subsection (a)(4) filed 12-3-85; effective thirtieth day thereafter
(Register 85, No. 49).
4. Change without regulatory effect of subsections (a)(2) and (a)(5) (A) 10. (Regis-
ter 87, No. 11).
5. Amendment of subsection (a)(3) filed 6-3-87; operative 7-3-87 (Register 87,
No. 47). Ed. Note: The changes to the text of subsection (a)(3) were printed in
Register 87, No. 24; however, the HISTORY NOTE was inadvertently omitted.
6. Amendment of subsecfion (a)(5) filed 4-17-89; operafive 5-17-89 (Register
89, No. 48).
7. Editorial correction of printing error in subsection (a)(5)(B)9. (Register 93, No.
13).
8. Amendment of secfion and Note filed 12-9-97; operative 1 -8-98 (Register 97,
No. 50).
§ 50374. MFBU Determination— Child Stays Alternately
with Each Parent.
(a) A child, who stays alternately for periods of one month or less with
each of his/her parents and the parents are separated or divorced, shall be
included in the MFBU of the parent specified in this section. The child
shall be included in the MFBU of the parent:
(1) With whom the child stays for the majority of time unless the other
parent can establish that he/she has majority responsibility, as defined in
(c), or care and control of the child.
(2) Who has majority responsibility, as defined in (c), when the child
spends an equal amount of time with each parent.
(3) Who applies for Medi-Cal on behalf of the child, when the child
spends an equal amount of time with each parent and each parent exer-
cises an equal share of care and control responsibilities. When both par-
ents apply for Medi-Cal for such a child, the child's MFBU shall be de-
termined in accordance with (b).
(b) A child described in (a) (3) shall be included in the MFBU of the
parent who solely meets one of the following conditions in the order spe-
cified. The parent who:
( 1 ) Is designated in a current court order as the primary parent for pur-
poses of public assistance, under Civil Code, Section 4600.5(h).
(2) Is eligible for Medi-Cal.
(3) Is designated, through mutual agreement of both parents, as the pri-
mary parent for purposes of public assistance.
(4) First applied for Medi-Cal on behalf of the child.
(c) For purposes of this section, when determining which parent has
majority responsibility for care of a child, the following factors shall be
considered. In addition, other similar factors shall also be considered as
a single factor may not be determinative. The determination shall in-
clude, the extent to which the parent:
(1) Decides where the child attends school.
(2) Deals with the school on educational decisions and problems.
(3) Controls participation in extracurricular and recreational activities.
(4) Arranges medical and dental care services.
(5) Claims the child as a tax dependent.
(6) Purchases and maintains the child's clothing.
(d) Once the MFBU has been determined with (a), (b) and (c), the child
shall remain in that MFBU while staying with the other parent for alter-
nating periods of one month or less. If the child stays with the other parent
consecutively for more than one month, then the child shall be included
in the MFBU of that parent.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Institutions
Code. Reference: Secfions 14005.7, 14008 and 14051, Welfare and Insfitutions
Code.
History
1. New secfion filed 4-17-89; operafive 5-17-89 (Register 89, No. 48).
§ 50375. Medi-Cal Family Budget Unit Determination,
Stepparent Cases.
(a) Family members in a family which includes a stepparent shall be
in the same MFBU unless only the separate children of one parent wish
to receive Medi-Cal.
(b) If the applicant requests that only the separate children of one par-
ent receive Medi-Cal, the right to make this choice and its effects shall
be explained to the applicant at the time of the face-to-face interview.
(c) The stepparent unit shall consist of the following:
(1) Stepparent.
(2) Parent.
(3) Mutual children.
(4) Stepparent's separate children.
(d) When only the separate children of one parent will receive Medi-
Cal:
(1) The parent of the separate children shall be an ineligible member
of the separate children's MFBU in accordance with Section 50379(e).
(2) The members of the stepparent unit, other than the parent of the
separate children shall be excluded from the MFBU in accordance with
Section 50381(b).
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Secfions 14005.4, 14005.7, 14008, 14051 and 14052, Welfare
and Institutions Code.
Page 350.1
Register 97, No. 50; 12-12-97
§ 50377
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
History
1. New section filed l-8-81;effective thirtieth day thereafter (Register 81, No. 2).
2. Amendment of subsection (c) filed 2-1 1-82; effective thirtieth day thereafter
(Register 82, No. 7).
3. Amendment of subsection (a)(3) filed 6-3-87; operative 7-3-87 (Register 87,
No. 24).
4. Amendment filed 12-9-97; operative 1-8-98 (Register 97, No. 30).
§ 50377. Medi-Cal Family Budget Unit (MFBU)
Determination, Family Member in Long-Term
Care or Board and Care.
(a) An aged, blind or disabled person who is in LTC or board and care
shall be in his/her own MFBU, except as provided in (c).
(b) An aged, blind or disabled person's spouse who is in LTC or board
and care shall be in his/her own MFBU, except as provided in (c).
(c) Spouses and their children shall be in the same MFB for property
evaluations until the end of the sixth full month of LTC or board and care
status when all of the following conditions are met:
(1) Both spouses are aged, Wind or disabled.
(2) One or both spouses is in LTC or board and care.
(3) Both spouses apply for and are eligible for Medi-Cal.
(d) A person who is in LTC or board and care who is not aged, blind
or disabled and whose spouse is not aged, blind or disabled shall be in-
cluded in the MFBU with the person's spouse, and/or children or, where
the person is a child, with the child's parents.
(e) A child who is a ward of the court or the responsibility of a public
agency due to a voluntary placement by a parent or guardian and who is
a patient in a medical facility shall be in the child's own MFBU.
(f) A child who is not blind or disabled, who is in LTC and who was
not living with the child's parents immediately prior to entering LTC
shall be in the child's own MFBU.
(g) Income and property available to the MFBUs established in accor-
dance with this section shall be determined in accordance with Sections
50557 and 50403.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Institutions
Code: and Section 5, Chapter 1221, Statutes of 1985. Reference: Sections 14005.4,
14005.7, 14005.16 and 14008, Welfare and Institutions Code.
History
1 . New section filed 1-8-81 ; effective thirtieth day thereafter (Register 81 , No. 2).
2. Amendment filed 12-2-85 as an emergency; effective upon filing (Register 85,
No. 50). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 4-1-86.
3. Amendment refiled 3-28-86 as an emergency; effective upon filing (Register
86,No. 13). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 7-28-86.
4. Certificate of Compliance as to 3-28-86 order filed 6-6-86 (Register 86, No.
23).
§ 50379. Ineligible Members of the Medi-Cal Family
Budget Unit.
(a) Persons who are ineligible for Medi-Cal for any of the following
reasons shall be ineligible members of the MFBU, as limited by (b).
(1) Refusal to apply for a Social Security number except as specified
in Section 50302(c).
(2) Refusal to apply for a Medicare health insurance claim number.
(3) Refusal to apply for and accept unconditionally available income.
(4) Inability to meet the basic eligibility criteria for any of the Medi-
Cal programs.
(5) Parents who reside outside the state and who claim their children
residing in the state as dependents in order to receive a tax credit or de-
duction for state or federal income tax purposes.
(6) Refusal by a parent or caretaker relative to assign to the state all
rights to medical support and payments for medical care from any third
party.
(7) Refusal by a parent or caretaker relative, without good cause as
specified in Section 50771.5, to cooperate in establishing paternity for a
child under eighteen years of age bom out of wedlock for whom Medi-
Cal is requested and in obtaining medical support and payments, and in
identifying and providing information concerning any third party who is
or may be liable to pay for medical care or support.
(b) A child ineligible for Medi-Cal for any of the reasons hsted in (a)
who has separate income or property may be treated as an ineligible
member of the MFBU or be excluded from the MFBU in accordance with
Section 50381. This choice is the option of the person who has legal re-
sponsibiUty for the child.
(c) Persons who are eligible for four month continuing eligibility or
Transitional Medi-Cal shall be ineligible members of the MFBU.
(d) Minor parents living with their parents shall be ineligible members
of the MFBU that includes the minor parent's cliildren except when the
minor parent wishes to receive only minor consent services. Minor par-
ents who wish to receive Medi-Cal, other than minor consent services,
shall be included in the MFBU with their parents.
(e) The parent of the separate children in a stepparent case who are the
only family members who wish to receive Medi-Cal in accordance with
Section 50375 shall be an ineligible member of the separate children's
MFBU.
(f) The following persons shall be ineligible members of the MFBU
when a person 1 8 to 21 is claimed by his/her parent as a dependent in or-
der to receive a tax credit or deduction for state or federal income taxa-
tion:
(1) The spouse, children, and parent(s) of the person 1 8 to 21 claimed
as a tax dependent shall be ineligible members of the MFBU which in-
cludes the tax dependent.
(2) The person 18 to 21 claimed as a tax dependent shall be an ineligble
member of the MFBUs which include either:
(A) His/her parent(s).
(B) His/her spouse and children.
(g) Ineligible members of a MFBU shall:
(1) Be included in the MFBU for the purpose of determining eligibility
based on property and share of cost.
(2) Have their health care costs used to meet the share of cost.
(3) Not be issued a Medi-Cal card.
Note: Authority cited: Secfions 10725 and 14124.5, Welfare and Institutions
Code; Section 87(c), Chapter 1594, Statutes of 1982; and Section 14, Chapter
1447, Statutes of 1984. Reference: Sections 14005.4, 14005.7, 14005.8, 14005.12,
14007.1, 14008 and 14008.6, Welfare and Insfitufions Code; Title 42, Section
1 396r-6, UNited States Code; and 42 C.F.R. Secfions 433. 1 35. 433. 1 36, 433. 1 37,
433.138, 433.145, 433.146, 433.147, 433.148 and 435.604.
History
1 . New section filed 1 -8-8 1 ; effective thirtieth day thereafter (Register 8 1 , No. 2).
2. New subsecfions (a)(5)-(6), filed 10-1-82 as an emergency; effective upon fil-
ing (Register 82, No. 40). A Certificate of Compliance must be transmitted to
OAL within 120 days or emergency language will be repealed on 1-29-83.
3. Relettering of subsection (0 to subsection (g) and new subsection (f) filed
12-21-82 as an emergency; effecfive upon filing (Register 82, No. 52). A Cer-
tificate of Compliance must be transmitted to OAL within 120 days or emergen-
cy language will be repealed on 4-20-83.
4. Amendment of subsection (a)(5) filed 12-31-82 as an emergency; effective
upon filing (Register 83, No. 2). A Certificate of Compliance must be trans-
mitted to OAL within 120 days or emergency language will be repealed on
4-30-83.
5. Certificate of Compliance as to 10-1-82 order transmitted to OAL 1 -28-83 and
filed 2-28-83 (Register 83, No. 10).
6. Certificate of Compliance as to 12-21-82 order transmitted to OAL 4-19-83
and filed 5-16-83 (Register 83, No. 21).
7. Certificate of Compliance as to 12-31-82 order transmitted to OAL 4-13-83
and filed 5-16-83 (Register 83, No. 21).
8. Amendment of subsections (c) and (g)(2) filed 4-1 5-85 as an emergency; effec-
five upon fifing (Register 85, No. 16). A Certificate of Compliance must be
transmitted to OAL within 120 days or emergency language will be repealed on
8-13-85.
9. Certificate of Compliance including amendment of subsection (g)(2) trans-
mitted to OAL 8-13-85 and filed 9-18-85 (Register 85, No. 38).
10. New subsecfions (a)(7) and (a)(8) and amendment of Note; filed 4-16-93 as
an emergency; operafive 4-16-93 (Register 93, No. 16). A Certificate of Com-
pliance must be transmitted to OAL 8-16-93 or emergency language will be re-
pealed by operation of law on the following day.
•
Page 350.2
Register 97, No. 50; 12-12-97
Title 22
Health Care Services
§ 50404
1 1 . Certificate of Compliance as to 4- 1 6-93 order including amendment of Note
transmitted to OAL 8-13-93 and filed 9-23-93 (Register 93, No. 39).
12. Amendment of section and Note filed 12-9-97; operative 1-8-98 (Register
97, No. 50).
§ 50381 . Persons Excluded from the Medi-Cal Family
Budget Unit.
(a) Any child, other than an unborn or an infant during the first two
months of life, may be excluded from the MFBU. This choice shall be the
option of the person who has legal responsibility for the child. Excluded
children shall not:
(1) Apply separately unless they apply for minor consent services.
(2) Be included in the MFBU for the purpose of determining eligibility
and share of cost.
(3) Be considered in determining the program for which the persons
included in the MFBU are eligible.
(4) Have their health care costs used to meet the MFBU's share of cost.
(b) All the members of the stepparent unit established in accordance
with Section 50375, other than the parent of the separate children receiv-
ing Medi-Cal, shall be considered excluded from the MFBU. The ex-
cluded members shall not:
(1) Apply separately unless they apply for minor consent services.
(2) Be included in the MFBU for the purpose of determining eligibility
and share of cost.
(3) Have their health care costs used to meet the MFBU's share of cost.
(c) The county department shall explain to the applicant who has a
choice of being included or excluded from the MFBU the advantages and
disadvantages of such an action before the choice is made.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4, 14005.7 and 14008, Welfare and Institutions
Code.
History
1. New section filed 1-8-81 ; effective thirtieth day thereafter (Register 81, No. 2).
2. Amendment of subsections (a), (a)(4) and (b)(3) filed 12-9-97; operative
1-8-98 (Register 97, No. 50).
Article 9. Property
§ 50401 . Property Evaluation.
(a) After determining the appropriate Medi-Cal program for the mem-
bers of the MFBU, the county department shall evaluate the property
holdings of the MFBU to determine:
(1) Property to be included in determining eligibility.
(2) The value of the included property.
(3) Whether the total value of the included property exceeds the prop-
erty reserve limits specified in Section 50420.
(b) After determining the value of all property to be included in the
property reserve of the MFBU, the value shall be waived for a pregnant
woman and/or infant if those applicants or beneficiaries are found to be
eUgible under the 200 Percent program as provided in Section 50262(a).
(c) When determining eligibility under the Percent programs, as de-
scribed under Sections 50262.5 and 50262.6, property shall be disre-
garded.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14006, 14148.5 and 14 148.75, Welfare and Institutions
Code.
History
1. Editorial correction adding Note filed 6-10-83 (Register 83, No. 24).
2. New subsection (b) and amendment of Note filed 5-28-92 as an emergency;
operative 5-28-92 (Register 92, No. 22). A Certificate of Compliance must be
transmitted to OAL 9-25-92 or emergency language will be repealed by opera-
tion of law on the following day.
3. Certificate of Compliance as to 5-28-92 order transmitted to OAL 9-25-92 and
filed 10-19-92 (Register 92, No. 43).
4. New subsection (c) and amendment of Note filed 4-2-98 as an emergency; op-
erative 4-2-98. SubmJtted to OAL for printing only pursuant to Welfare and In-
stitutions Code section 14148.75 (Register 98, No. 16). A Certificate of Com-
pliance must be transmitted to OAL by 9-29-98 or emergency language will be
repealed by operation of law on the following day.
5. Editorial coixection of History 4 (Register 98, No. 47).
6. Reinstatement of section as it existed prior to 4-2-98 emergency amendment
by operation of Government Code section 1 1346.1(f) (Register 98, No. 47).
7. New subsection (c) and amendment of NOTE filed 11-18-98; operative
11-1 8-98 (Register 98, No. 47).
§ 50402. Availability of Property.
Property which is not available shall not be considered in determining
eligibility.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institufions
Code. Reference: Section 14006, Welfare and Institutions Code.
History
1. Chanse without regulatory effect adding NOTE filed 10-1 1-88 (Register 88,
No. 45).
§ 50403. Treatment of Property: Separate and Community
Property.
(a) The separate property and share of community property of any per-
son included in the MFBU shall be considered in determining Medi-Cal
eligibility.
(b) A spouse's share of community property is always one-half of the
current total community property.
(c) For purposes of establishing eligibility, an interspousal agreement
entered into pursuant to Welfare and Institutions Code Section 14006.2
shall:
(1) be written, dated and signed by both spouses or by a person who
has the legal authority to enter into such agreements on behalf of either
spouse;
(2) list each asset being transmuted;
(3) clearly designate the owner of each asset;
(4) list the value of each asset; and
(5) evidence an equal division of the nonexempt community property.
(d) If an interspousal agreement does not comply with (c)(4) of this
section, the county shall request additional information from the appli-
cant, or other party mentioned in (c)(1) to supplement the agreement and
verify the methodology used to value assets. Such information may be
necessary pursuant to verification requirements contained in Article 4 of
this Division.
(e) If an interspousal agreement evidences an unequal division of the
nonexempt community property, and the applicant received the smaller
share of such property under the agreement, the county shall determine
whether the transfer was for adequate consideration in accordance with
Sections 50408 and 50409.
(1) If the county determines that the transfer was not for adequate con-
sideration and was made in order to establish eligibility or to reduce the
share of cost, the county shall give the applicant's spouse the option of
reconveying to the applicant in accordance with Section 5041 1(d)(1) an
amount of property sufficient to provide each spouse with equal shares
of the total nonexempt community property identified in the interspousal
agreement.
(2) If the applicant's spouse does not reconvey property pursuant to
(e)( 1) above, the county shall assess a period of ineligibility for the appli-
cant in accordance with Section 50411.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14006, 14006.2, 14008, 14008.5 and 14015, Welfare
and Institutions Code.
History
1 . Amendment filed 1 -8-8 1 ; effective thirtieth day thereafter (Register 8 1 , No. 2).
2. New subsections (c), (d) and (e) filed 1 1-16-88; operative 11-16-88 pursuant
to Government Code Section 11346.2(d) (Register 88, No. 49).
§ 50404. Owner of Property.
(a) The owner of property, for Medi-Cal eligibility purposes, shall be
the person who holds legal title to the property unless otherwise specified
in these regulations.
(b) Ownership of property may be vested in one individual or shared
with other individuals.
Page 350.3
Register 98, No. 47; 11-20-S
§ 50405
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
(c) Notwithstanding (a), a person shall be the owner of separate prop-
erty designated in a written interspousal agreement.
NOTE: Authority cited: Sections 10723 and J4124.5. Welfare and Institutions
Code. Reference: Sections 14006 and 14006.2, Welfare and institutions Code.
History
1. New subsection (c) fded 2-16-88 as an emergency; operative 2-16-88 (Regis-
ter 88, No. 10). A Certificate of Compliance must be transmitted to OAL within
120 days or emergency language will be repealed on 6-13-88.
2. New subsection (c)refiled 6-16-88 as an emergency; operative 6-16-88 (Reg-
ister 88, No. 26). A Certificate of Compliance must be transmitted to OAL with-
in 120 days or emergency language will be repealed on 10-14-88.
3. Emergency language of new subsection (c) refiled and operative 6-16-88 re-
pealed on 10- 14-88 by operation ofGovemment Code Section 11346.1 (Regis-
ter 88, No. 49).
4. New subsection (c) filed 1 1-16-88; operative 1 1-16-88 pursuant to Govern-
ment Code Section 1 1346.2(d) (Register 88, No. 49).
§ 50405. Contracts of Sale.
(a) Property purchased under a sigtied contract of sale by the applicant
or beneficiary shall be included in the property reserve of the applicant
or beneficiary.
(b) Property being sold by the applicant or beneficiary under a signed
contract of sale shall not be considered the property of the applicant or
beneficiary. The interest payments received under the contract of sale
shall be unearned income. The principal payments received under the
contract of sale shall be property.
(c) Property being purchased or sold under a verbal or unsigned con-
tract of sale shall be considered the property of the seller until the sale is
complete.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14006, Welfare and Institutions Code.
History
1. Change without regulatory effect adding NOTE filed 10-1 1-88 (Register 88,
No. 45).
§ 50406. Conversion or Transfer of Property.
Conversion or transfer of property may affect eligibility. Sections
50407 through 50411 describe methods of converting or transferring
property, and the effect of each method on eligibility.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14006 and 14015, Welfare and Institutions Code.
History
1. Change without regulatory effect adding NOTE filed 10-1 1-88 (Register 88,
No. 45).
§ 50407. Conversion of Property — Treatment.
(a) Conversion of property in itself from one form to another has no
effect on eligibility; however, the property obtained through a conver-
sion may have an effect on eligibility and therefore shall be evaluated to
determine its effect.
(b) Insurance or other third-party payments for the loss or damage of
property shall be treated as converted property rather than income.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14006 and 14015, Welfare and Institutions Code.
History
1. Change without regulatoi7 effect addine NOTE filed 10-11-88 (Reaister 88,
No. 45).
§ 50408. Transfer of Property Which Does Not Result in
Ineligibility.
(a) Transfer of property shall not result in ineligibility for Medi-Cal
under any of the following conditions:
(1 ) The property would have been considered exempt pursuant to Sec-
tion 50418 of Article 9 of Division 3 of this title at the time of transfer.
(2) The net market value of the property transferred, when included in
the property reserve, would not result in ineligibility. The determination
of value shall be made as of the time of transfer. If eligibility exists, the
value of the property shall no longer be considered.
(3) Adequate consideration is received. Adequate consideration is the
fair market value of the property as defined in Section 50412 and in-
cludes:
(A) A transfer which was to satisfy a legal debt.
(B) A transfer which was to reimburse someone other than a responsi-
ble relative, as specified in Section 50351, for care or benefits provided
on the basis of an agreement or understanding that reimbursement would
be made. The applicant or beneficiary shall provide evidence that clearly
estabhshes that the value of the care or benefits provided was reasonably
equivalent to the value of the property transferred.
(C) A written transmutation of a married couple's nonexempt commu-
nity property into equal shares of separate property through an interspou-
sal agreement.
(4) Foreclosure or repossession of the property was imminent at the
time of transfer, and there is no evidence of collusion.
(5) The transfer was made in return for an enforceable contract for life
care which does not include complete medical care. In this case, each full
item of need provided under the life care contract shall be considered in-
come in kind in accordance with Section 50509.
(6) The transfer was made without adequate consideration but the
applicant or beneficiary provides convincing evidence to the county as
specified in Section 50409(b), to overcome the presumption that the
•
[The next page is 351.
Page 350.4
Register 98, No. 47; 11-20-98
Title 22
Health Care Services
§ 50412
transfer was for the purpose of establishing eligibility or reducing the
share of cost.
(b) There is a presumption that property transferred by the applicant
or beneficiary more than two years preceding the date of initial applica-
tion was not transferred to establish eligibility or reduce the share of cost.
Such property shall not be considered in determining eligibility.
(c) While the transfer of property by an applicant or beneficiary from
one form to another, as described in (a) above, has no effect on eligibihty,
any property obtained by an applicant or beneficiary through such a
transfer may have an effect on eligibility and therefore shall be evaluated
to determine its effect.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14006, 14006.2 and 14015, Welfare and Institutions
Code.
History
1. Amendment of subsection (b) filed 12-15-77; effective thirtieth day thereafter
(Register 77, No. 51).
2. Amendment filed 3-7-80; effective thirtieth day thereafter (Register 80, No. 9).
3. New subsection (a)(2)(C) filed 2-16-88 as an emergency; operative 2-16-88
(Register 88, No. 10). A Certificate of Compliance must be transmitted to OAL
within 120 days or einergency language will be repealed on 6-15-88.
4. New subsecfion (a)(2)(C) refiled 6-16-88 as an emergency; operative 6-16-88
(Register 88, No. 26). A Certificate of Compliance must be transmitted to OAL
within 120 days or emergency language will be repealed on 10-14-88.
5. Amendment filed 6-28-88; operative 7-28-88 (Register 88, No. 27).
6. New subsection (a)(2)(C) refiled and operative 6-16-88 repealed 10-14-88
pursuant to Government Code Section 1 1346.1 (Register 88, No. 49).
7. New subsection (a)(2)(C) filed 1 1-1 6-88; operative 1 1-1 6-88 pursuant to Gov-
ernment Code Section 1 1346.2(d) (Register 88, No. 49).
§ 50409. Transfer of Property Which Results in Ineligibility.
(a) Transfer of property shall result in ineligibility for Medi-Cal if:
(1) the transfer met none of the conditions specified in Section 50408;
or
(2) the transfer was in return for an enforceable life care contract which
includes complete medical care.
(b) Transfer of property without adequate consideration shall result in
ineligibility for Medi-Cal if the transfer was made to establish eligibility
or to reduce the share of cost.
(J) It shall be presumed that property transferred without adequate
consideration was for the purpose of establishing ehgibility or to reduce
the share of cost as limited by (2).
(2) To overcome the presumption, the applicant or beneficiary has the
burden of establishing that this presumption is not correct.
(A) The applicant or beneficiary shall provide evidence which may in-
clude verification of the onset of traumatic injury or illness, diagnosis of
a previously undetected disability condition or unexpected loss of in-
come or resources after transfer and/or that adequate resources were
available at the time of the transfer of property for support and medical
care considering such things as the applicant's or beneficiary's age,
health, life expectancy, and ability to understand extent of resources.
(B) Such evidence may also include other subjective evidence includ-
ing, but not limited to. evidence that the claimant transferred in order to
avoid probate and/or that the claimant had no knowledge of Medi-Cal or
its benefits at the time of the transfer.
(C) However, any such evidence presented must be convincing evi-
dence in order to overcome the presumption stated in (b)(1) above.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14006 and 14015, Welfare and Institutions Code.
History
1. Amendment of subsection (a) filed 12-15-77; effective thirtieth day thereafter
(Register77, No. 51).
2. Editorial correction adding NOTE filed 6-10-83 (Register 83, No. 24).
3. Amendment filed 6-28-88; operative 7-28-88 (Register 88, No. 27).
§ 50410. Transfer of Property with Retention of a Life
Estate.
Property transferred by the applicant or beneficiary with retention of
a life estate shall be treated as any other transfer to determine whether the
transfer results in ineligibility.
Note: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14015, Welfare and Insfitutions Code.
History
1 . Editorial correction adding NOTE filed 6-10-83 (Register 83, No. 24).
§ 5041 1 . Period of Ineligibility Due to Transfer of Property.
(a) Following a determination of ineligibility due to the transfer of
property, there shall be a period of ineligibility. This period shall be the
time during which the net market value of the property at the time of
transfer, less consideration received, would have supported the applicant
or beneficiary and the applicant's or beneficiary's family.
(b) The period of ineligibility shall be computed in the following inan-
ner:
Determine the net market value of the property at the time of transfer
less any consideration received which is the net value of the property
transferred.
(2) Determine the portion of the net value of the property transferred
which, if included in the property reserve at the time of transfer, would
not have caused such reserve to exceed the property limit that was appli-
cable at that time.
(3) The portion of the net value of the property transferred that would
not have fallen within the property limit at the time of transfer is the ex-
cess net value of the property transferred and shall be used to determine
the period of ineligibility.
(4) The number of months in the period of ineligibility shall be deter-
mined by dividing the excess net value of the property transferred by the
monthly maintenance need for the applicant or beneficiary and the appli-
cant's or beneficiary's family. The maintenance needs used shall be the
maintenance needs in effect during each individual month since the date
of the transfer. Income received by the family after the transfer shall not
affect this computation.
(5) The period of ineligibility may be further reduced by deducting the
actual cost to the applicant or beneficiary of the following:
(A) Medical expenses.
(B) Out-of-home care costs in excess of the maintenance needs.
(C) Major home repairs necessary to put the home into a liveable con-
dition.
(c) The period of ineligibility shall begin the first of the month follow-
ing the date the transfer which resulted in ineligibility occurred, unless
a 10 day notice is required and cannot be given. In that case, the period
of ineligibility shall begin the first of the next month.
(d) The period of ineligibility shall end when any of the following situ-
ations occur:
(1) The property which was transferred and caused ineligibility is re-
conveyed to the applicant or beneficiary.
(2) The applicant or beneficiary receives adequate consideration for
the property.
(3) Deduction of the amounts specified in (b) (4) and (5) has reduced
the excess net market value to zero.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14006 and 14015, Welfare and Insfitutions Code.
History
1. Amendment of subsection (b)(4) and (b)(5) filed 12-15-77; effective thirtieth
day thereafter (Register 77, ^fo. 51).
2. Editorial con-ection adding NOTE filed 6-10-83 (Register 83, No. 24).
§ 5041 2. Market Value of Property.
(a) The market value of real property shall be (1) or (2), unless the
applicant or beneficiary chooses to meet the conditions of (3), and (3) is
lower:
(1) The assessed value determined under the most recent property tax
assessment, if the property is located in California.
Page 351
(4-1-90)
§ 50413
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
(2) The value established by applying the assessment method used in
the area where the property is located, if the property is located outside
of California.
(3) The value established as the result of an appraisal by a qualified real
estate appraiser, if the appraisal is obtained by the applicant or beneficia-
ry and provided to the county department.
(b) The market value of each item of personal property shall be deter-
mined by the specific methods contained in this article.
(c) The market value of notes secured by deeds of trust and mortgages
which are considered as other real property in accordance with Section
50441(b) shall be established in accordance with Section 50441(c).
NOTE; Authority cited; Sections 10725, 14006.1 and 14124.5, Welfaie and Insti-
tutions Code; and Section 57, Chapter 328, Statutes of 1982. Reference; Sections
1 1 153.7 and 14006, Welfare and Institutions Code.
History
1 . Amendment filed 1-28-77 as an emergency; effective upon filing (Register 77,
No. 5).
2. Certificate of Compliance filed 4-22-77 (Register 77, No. 17).
3. Amendment of subsections (a)(3) and (c) filed 5-6-81; effective thirtieth day
thereafter (Register 81 , No. 19).
4. Amendment of subsection (a)(1) filed 12-31-82 as an emergency; effective
upon filing (Register 83, No. 2). A Certificate of Compliance must be trans-
mitted to OAL within 120 days or emergency language will be repealed on
4-30-83.
5. Certificate of Compliance transmitted to OAL 4-29-83 and filed 6-3-83 (Reg-
ister 83, No. 23).
6. Amendment of subsection (a)(3) filed 7-24-84 as an emergency; effective upon
filing (Register 84, No. 31). A Certificate of Compliance must be transmitted
to OAL within 120 days or emergency language will be repealed on 11-21-84.
7. Order of Repeal of 7-24-84 emergency order filed 12-20-84 by OAL pursuant
to Government Code Section 1 1349.6 (Register 84, No. 51).
8. Amendment of subsection (a)(3) filed 12-2-85 as an emergency; effective upon
filing (Register 85, No. 50). A Certificate of Compliance must be transmitted
to OAL within 120 days or emergency language will be repealed on 4-1-86.
9. Certificate of Compliance transmitted to OAL 3-31-86 and filed 4-30-86
(Register 86, No. 18).
§50413. Encumbrances.
(a) Encumbrances of record are obligations for which the property is
security. Encumbrances include, but are not limited to:
(1) Loans.
(2) Attachments for debts and taxes.
(3) Chattel mortgages and liens.
NOTE: Authority cited; Sections 10725 and 14124.5, Welfare and Institufions
Code. Reference; Section 14006, Welfare and Institutions Code.
History
1. Editorial con-ection adding NOTE filed 6-10-83 (Register 83, No. 24).
§ 50414. Share of Encumbrances Determination.
(a) The share of encumbrances shall be determined as follows:
(1) Determine the total market value of the property.
(2) Determine the market value of the portion of the property that is
to be considered.
(3) Divide the amount determined in (2) by the amount determined in
(1) to obtain the percentage that the portion of property is of the total
property.
(4) Multiply the total encumbrances on the property by the percentage
determined in (3) above. This is the share of encumbrances.
§50415. Net Market Value of Property.
(a) The net market value of real or personal property is the owner's eq-
uity in that property.
(b) The net market value shall be determined by subtracting the en-
cumbrances of record from the market value.
(c) The net market value of real or personal property owned jointly
with other persons shall be determined by subtracting the beneficiary's
share of encumbrances from the beneficiary's interest in the property.
Note. Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference; Section 14006, Welfare and Institufions Code.
History
1. Change without regulatory effect adding NOTE filed 10-1 1-88 (Register 88,
No. 45).
§ 50416. Utilization Requirements.
(a) Other real property, as specified in Section 50427(b), shall be uti-
lized in order to be exempt unless the net market value, when added to
the net market vakie of other nonexempt property, falls within the limits
set forth in Section 50420.
(b) The property is utilized if any of the following requirements are
inet:
(1 ) The beneficiary is receiving net yearly income from the property
of at least six percent of the net market value of the property.
(A) For property not limited to .seasonal use, this requirement is met
if the net monthly income from the property is one-twelfth of six percent
of the net market value of the property.
(B) For property hmited to seasonal use, this requirement is inet if the
net yearly income is six percent of the net market value of the property.
Property limited to seasonal use includes, but is not limited to:
L Farmland.
2. Summer cabins.
(C) For purpose of determining net yearly income frotn property lim-
ited to seasonal use, the year is considered to begin in the first month of
the year in which income normally begins. Income from all months of the
year shall be considered in determining net yearly income of the proper-
ty, regardless of the eligibility status of the beneficiary in those months.
(2) The property has been sold, or the sale is in escrow and there is a
bona fide attempt to close the sale.
(c) The applicant or beneficiary shall be allowed six months to meet
utilization requirements. The six month period shall be known as the uti-
lization period, and shall begin on the first of the month following is-
suance of a notice of action informing the applicant or beneficiary that
the property is not yielding sufficient income, as required in (b). The utili-
zation period shall be stayed during periods of ineligibility in accordance
with (1).
(d) The utilization period may be extended for a maximum of one year
for good cause, as specified in Section 50417.
(e) The utilization period shall be extended for as long as the property
is Hsted for sale, provided all of the following conditions are met:
(1) The county department determines that utilization requirements
can only be met by sale of the property. This determination shall be made
using evidence provided by the applicant or beneficiary, which may be,
but is not limited to, either of the following:
(A) A written statement from a qualified real estate appraiser which
gives the appraisal value of the property and its income poteniial.
(B) A certificate of condemnation.
(2) The property is listed for sale with a licensed real estate broker at
the market value, as determined in accordance with Section 50412(a).
(3) The beneficiary provides the following evidence every six months,
and at any other time it is requested by the county department:
(A) A statement from the real estate agency that no bona fide offer has
been rejected.
(B) Copies of any offers that have been submitted and the reasons for
rejection.
(C) Evidence of the efforts being made to advertise the property for
sale.
(f) If the apphcant or beneficiary utilizes the property by sale, the prop-
erty shall be sold for at least market value, unless the property was sold
under either of the following situations, and the applicant or beneficiary
submits evidence that there was a bona fide attempt to sell at market val-
ue.
( 1 ) The property was listed with a hcensed real estate broker for at least
three inonths and the final sale price was similar to comparable sales in
the area.
(2) There was an inability to sell the property for the market value and
the county department determines that the final sale price was reason-
able.
Page 352
(4-1-90)
Title 22
Health Care Services
§ 50420
•
(g) An existing environmental impact report involving a property shall
be considered by the county department in determining the utilization po-
tential of the property.
(h) A life estate interest in real property shall be utilized in accordance
with this section.
(i) The applicant or beneficiary may arrange for a reassessment of the
property during the utilization period. The assessment shall affect utiliza-
tion as follows:
(1 ) The reassessment value shall be used in determining utilization re-
quirements.
(2) The reassessment shall not affect the beginning date or the length
of the utilization period.
(j) The entire net market value of property not utilized in accordance
with this section shall be included in the property reserve on the first of
the month following the last month of the utilization period.
(k) A utilization period shall begin whenever:
(1 ) An applicant, with other real property that is not being utilized, be-
comes eligible except as specified in (1).
(2) The other real property of a beneficiary, that has been utilized, is
no longer utilized.
(3) The net market value of other real property, when added to the net
market value of other nonexempt property, no longer falls within the lim-
its set forth in Section 50420.
(/ ) When a utilization period has begun and the beneficiary becomes
ineligible for Medi-Cal prior to its expiration, the remainder of the utili-
zation period shaU be applied if eligibility is subsequently reestablished
and the property is not utilized at that time. However, if the beneficiary
can verify that the property was utilized at any time during the period of
ineligibility, a new utilization period shall begin.
NOTE: Authority cited: Sections 10725, 14006.1 and 14124.5, Welfare and Insti-
tutions Code. Reference: Section 14006, Welfare and Institutions Code.
History
1. Amendment of subsections (e)(1)(A) and (k) filed 12-2-85 as an emergency;
effective upon filing (Register 85, No. 50). A Certificate of Compliance must
be transmitted to OAL within 120 days or emergency language will be repealed
on 4-1-86. For prior history, see Register 83, No. 4.
2. Certificate of Compliance transmitted to OAL 3-31-86 and filed 4-30-86
(Register 86, No. 18).
§ 50417. Utilization— Good Cause.
(a) Good cause, as required in Section 50416 (d), shall be found only
if the applicant or beneficiary has made a bona fide effort to meet utiliza-
tion requirements and is unable to do so because of circumstances be-
yond such person's control.
(b) Circumstances beyond a person's control shall include any of the
following situations:
(1) Death of a part owner of the property and inability or refusal of the
administrator or executor of the estate or other responsible person to
complete disposition of the property if such person is other than the appli-
cant or beneficiary.
(2) Misplaced reliance by the applicant or beneficiary upon what ap-
peared to be a bona fide offer. The county department shall require a copy
of the written offer for the property as evidence that the offer was bona
fide. Misplaced reliance may have resulted if the offer was either of the
following:
(A) Bona fide but the purchaser was unable to complete the purchase.
(B) Apparently bona fide but eventually found not to be bona fide.
(3) Prolonged illness causing the seller to be homebound or hospital-
ized during the ufihzation period and unable to take the necessary action
to meet utilizafion requirements or to arrange for an agent to do so.
(4) Like reasons which the county department determines meet the
general intent of good cause.
NOTE; Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 1 1 153.7 and 14006, Welfare and Institutions Code.
History
1. Editorial correction filed 6-10-83 (Register 83, No. 24).
§50418. Exemption of Property.
(a) Certain real and personal property is exempt and shall not be in-
cluded in determining eligibility. These property exemptions are speci-
fied in Sections 50425 through 50489.
(b) All real and personal property not exempt as specified in (a) is non-
exempt property.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14006, Welfaie and Institutions Code.
History
1. Change without regulatory effect adding NOTE filed 10-1 1-88 (Register 88,
No. 45).
§50419. Property Reserve.
The property reserve is the net market value of the nonexempt property
of those persons whose property is considered in determining the eligibil-
ity of the MFBU.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institufions
Code. Reference: Section 14006, Welfare and Institufions Code.
History
1. Change without regulatory effect adding NOTE filed 10-1 1-88 (Register 88,
No. 45).
§ 50420. Property Limit.
(a) The property reserve shall not exceed the following limits.
Number of Persons Property
Whose Property is Limit
Considered 1985
1 person 1,600
2 persons 2,400
3 persons 2,550
4 persons 2,700
5 persons 2,850
6 persons 3,000
7 persons 3,150
8 persons 3,300
9 persons 3,450
10 persons or more 3,600
Property
Limit
1986
1,700
2,550
2,700
2,850
3,000
3,150
3,300
3,450
3,600
3,750
'roperty
Property
Limit
Limit
1987
1988
1,800
1,900
2,700
2,850
2,850
3,000
3,000
3,150
3,150
3,300
3,300
3,450
3,450
3,600
3,600
3,750
3,750
3,900
3,900
4,050
Property
Limit
1989
2,000
3,000
3,150
3,300
3,450
3,600
3,750
3.900
4.050
4,200
Page 353
Register 93, Nos. 52-53; 12-31 -93
§ 50420.5
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
(b) The members of the MFBU shall be ineligible for Medi-Cal if the
condition specified in (a) above is not met at some time during the month
in which application is made.
(c) If the property reserve has been in excess of the property limit from
the first day of the month of application through the date of application
the MFBU shall be eligible under the following conditions:
(1) The property reserve is brought within the property limit in any
manner other than transfer without adequate consideration by the last day
of the month of application.
(2) All other conditions of eligibility are met.
(d) The provisions of this regulation also apply to eligibility determi-
nations or redeterminations made retroactively to January 1, 1985.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; and Section 57(c), Chapter 328, Statutes of 1982. Reference: Sections
14006 and 14019.6, Welfare and Institutions Code.
History
1 . Amendment of subsection (a), (b) and new subsection (d) filed 4-15-85 as an
emergency; effective upon filing (Register 85, No. 16). A Certificate of Com-
pliance must be transmitted to OAL within 120 days or emergency language
will be repealed on 8-13-85. For prior history, see Register 83, No. 16.
2. Certificate of Compliance as to 4-15-85 order transmitted to OAL 8-13-85 and
filed 9-18-85 (Register 85, No. 38).
§ 50420.5. Separation of Community Property: Spouse in
Long-Term Care Facility.
(a) The value of property available to an applicant or beneficiary who
is in a skilled nursing or intermediate care facility and is in a MFBU sepa-
rate from his or her spouse shall be determined to meet the property re-
serve limits if the value as determined in (1)(E) or (2)(D) of this subsec-
tion is equal to or less than the applicable property reserve limit.
(1) If the applicant or beneficiary has entered into an interspousal
agreement prior to or on the date of entry into a skilled nursing or interme-
diate care facility and the agreement meets the requirements set forth in
section 50403(c) and (d), the county shall determine:
(A) The value of the applicant or beneficiary's nonexempt separate
property resulting from the interspousal agreement.
(B) The value of the applicant or beneficiary's one-half share of any
nonexempt community property acquired since or not included in the in-
terspousal agreement.
(C) The value of the applicant or beneficiary's nonexempt separate
property from sources other than the interspousal agreement.
(D) Tlie value of any nonexempt separate property owned by the appli-
cant or beneficiary's spouse and/or the applicant or beneficiary's
spouse's share of nonexempt community property which is actually
made available to the applicant or beneficiary.
(E) The value of property determined in (a)(1)(A) through (D) of this
section remaining after deducting expenditures made for the applicant or
beneficiary's own benefit as defined in (b) of this section and verified
losses, if any, in the market value of such property since the date of the
interspousal agreement.
(2) If the date the interspousal agreement was executed is later than the
date of entry into a skilled nursing or intermediate care facility, or in the
absence of an interspousal agreement which meets the requirements of
section 50403 (c), (d) and (e), the county shall determine:
(A) The value of the applicant or beneficiary's nonexempt separate
and one-half share of nonexempt community property on the date of
most recent entry, as limited by (d) of this section, into a skilled nursing
or intermediate care facility.
(B) The value of the applicant or beneficiary's share of any nonexempt
separate and one-half share of nonexempt community property acquired
from the date of most recent entry into a skilled nursing or intermediate
care facility to the date eligibility is determined.
(C) The value of any nonexempt separate property owned by the appli-
cant or beneficiary's spouse and/or the applicant or beneficiary's
spouse's share of nonexempt community property which is actually
made available to the applicant or beneficiary.
(D) The value of property determined in (a)(2)(A) through (C) of this
section remaining after deducting expenditures made for the applicant or
beneficiary's own benefit, as defined in (b) of this section, and verified
losses, if any, in the market value of such property since the date of entry
into a skilled nursing or intermediate care facility.
(b) Expenditures for the applicant or beneficiary's own benefit shall
include but are not limited to:
(1) Expenditures for the applicant or beneficiary's own medical ex-
penses.
(2) Expenditures associated with property owned by the applicant or
beneficiary and for improvements to such property in proportion to his
or her ownership interest in the property, for example.
(A) Payments made on the mortgage on a jointly owned principal resi-
dence.
(B) Payments made on a note on a jointly owned motor vehicle.
(C) Expenditures for improvements on a jointly owned principal resi-
dence.
(3) Expenditures for other exempt or nonexempt property for the sole
benefit of the applicant or beneficiary including, but not limited to, per-
sonal effects, recreational items, and burial trusts.
(4) Transfer of nonexempt assets for adequate consideration as de-
fined in 50408(a)(3).
(c) For purposes of this section, it shall be presumed that all property
is community property. This presumpfion may be rebutted by either
spouse.
(d) The mere change of residence from one medical facility to another
shall not be considered a new entry into LTC for purposes of subsecUon
(a) of this section.
(e) Effective 1/1/90, the regulations contained in this section shall not
apply to an institutionalized spouse as defined by secfion 1924 (h)(1) of
Title XIX of the Social Security Act.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14006, 14006.2 and 14008, Welfaie and Institutions
Code; and Section 1924, Title XIX, Social Security Act (Section 1396r-5, Title
42, United States Code).
History
1. New section filed 10-13-89 as an emergency pursuant to Sections 5 and 6(d)
of Chapter 1221, Statutes of 1985; operative 10-13-89 (Register 89. No. 44).
A Certificate of Compliance must be transmitted to OAL v/ithin 120 days or
emergency language will be repealed on 2-13-90.
2. New section filed 2-26-90 as an emergency pursuant to Sections 5 and 6(d) of
Chapter 1221, Statutes of 1985; operative 2-26-90 (Register 90, No. 9). A Cer-
tificate of Compliance must be transmitted to OAL within 120 days or emergen-
cy language will be repealed by operation of law on 6-26-90.
3. Certificate of Compliance as to 2-26-90 order including amendment of subsec-
tions (a) and (b) transmitted to OAL 6-8-90 and filed 7-9-90 (Register 90, No.
34).
§ 50421. Limits and l\/lethods of Property Determination for
the Qualified IVIedicare Beneficiary (QiVIB) or
the Specified Low-Income Medicare
Beneficiary (SLMB).
(a) To qualify for the QMB or SLMB programs, the net nonexempt
property of a QMB or SLMB applicant/beneficiary cannot exceed twice
the Supplemental Security Income (SSI) program property limit.
(1) Adult.
(A) A QMB or SLMB applicant/beneficiary who is married or is IB
years of age or older shall be considered an adult for pur{)oses of this sec-
tion.
(B) Only the property of the QMB or SLMB applicant/beneficiary and
his/her spouse, if living in the home, shall be considered in determining
net nonexempt property. Such property shall be determined in accor-
dance with Article 9 and shall be compared to twice the SSI property limit
for one person (or two persons, if the spouse is living in the home).
(2) Child.
(A) A QMB or SLMB applicant/beneficiary who is unmarried and
younger than 18 years of age shall be considered a child for purposes of
this section.
Page 354
Register 93, Nos. 52-53; 12-31-93
Title 22
Health Care Services
§ 50425
(B) Net nonexeinpt property shall be determined in accordance with
article 9. Only the property of the QMB or SLMB child and his/her par-
ent(s) shall be considered in determining net nonexempt property. For
purposes of this subsection, the parent(s) includes stepparent(s).
(C) The parent(s)'s net nonexempt property shall be compared to the
SSI property limit for one or two persons (depending upon the number
of parents in the home). If the parent(s)'s net nonexempt property does
not exceed this property limit, only the QMB or SLMB child's property
shall be considered. If the parent(s)'s net nonexempt property exceeds
the SSI property limit, the excess amount over the SSI property limit shall
be added to the QMB or SLMB child's own net nonexempt property. The
QMB or SLMB child's total net nonexempt property shall be compared
to twice the Medi-Cal property limit for one person.
(D) If there are two or more QMB or SLMB children in the home, the
excess amount of the parent(s)'s net nonexempt property over the SSI
property limit shall be divided by the number of QMB or SLMB children
and that quotient added to each child's net nonexempt property. The net
nonexempt property of the QMB or SLMB child shall no longer be in-
creased by his/her share of the parental allocation when:
1. The parental allocation of net nonexempt property when added to
the QMB or SLMB child's own net nonexempt property exceeds twice
the SSI property limit for one person, or
2. The QMB or SLMB child is found ineligible as a QMB or SLMB
for any other reason. When a QMB or SLMB child no longer qualifies
to receive a share of the parent(s)'s nonexempt property, the parent(s)'s
net nonexempt property shall then be redi vided by the number of remain-
ing QMB or SLMB children in the home and that quotient added to the
net nonexempt property of each of those children.
NOTE: Authority cited: Sections 10725, 14005.11 and 14124.5, Welfare and Insti-
tutions Code; and Section 12, Chapter 1430, Statutes of 1989. Reference: Sections
416. 1202 and 416.1205, Title 20, Code of Federal Regulations; Section 1396a(a),
Title 42, United States Code; and Section 14005.11, Welfare and Institutions
Code.
History
1. New section filed 8-13-90 as an emergency; operative 8-13-90 (Register 90,
No. 40). A Certificate of Compliance must be transmitted to OAL by 12-11-90
or emergency language will be repealed by operation of law on the following
day.
2. Certificate of Compliance transmitted to OAL 12-11-90 and filed 1-9-91
(Register 91, No. 8).
3. Amendment filed 12-21-93; operative 1-20-94 (Register 93, No. 52).
§ 50421 .5. Limits and Methods of Property Determination
for the Qualified Disabled and Working
Individual (QDWI).
(a) To qualify for the QDWI program, the net nonexempt property of
a QDWI applicant/beneficiary cannot exceed twice the Supplemental Se-
curity Income (SSI) resource limit in accordance with Section 1613, Title
XVI of the Social Security Act.
(b) Only the property of the QDWI applicant/beneficiary and, if mar-
ried, his/her spouse, if living in the home, shall be considered in deter-
mining net nonexempt property. Such property shall be determined in ac-
cordance with Section 50420.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; and Section 12, Chapter 1430, Statutes of 1989. Reference: Section
14005.3, Welfare and Institutions Code; and Sections I396a(a)(]0)(E) and
1396d(s), Title 42, United States Code.
History
1. New section filed 10-3-94 as an emergency; operative 10-3-94 (Register 94,
No. 40). A Certificate of Compliance must be transmitted to OAL by 1-31-95
or emergency language will be repealed by operation of law on the following
day.
2. Editorial correction of History Note 1 (Register 95, No. 9).
3. Repealed by operation of Government Code section 11346.1(g) (Register 95,
No. 9).
4. New section refiled 3-3-95 as an emergency; operative 3-3-95 (Register 95,
No. 9). A Certificate of Compliance must be transmitted to OAL by 7-1-95 or
emergency language will be repealed by operation of law on the following day.
5. Certificate of Compliance as to 3-3-95 order including amendment of subsec-
tion (b) and Note transmitted to OAL 2-22-95 and filed 4-5-95 (Register 95,
No. 14).
§ 50422. Liens.
NOTE: Authority cited: Sections 10725, 14006.1 and 14124.5. Welfare and Insti-
tutions Code. Reference: Section 14006, Welfare and Institutions Code.
History
1 . New section filed 7-24-84 as an emergency; effective upon filing (Register 84,
No. 31). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 1 1-21-84.
2. Order of Repeal of 7-24-84 emergency order filed 1 2-20-84 by OAL pursuant
to Goveminent Code Section 1 1349.6 (Register 84, No. 51).
§ 50423. Items of Property to Be Considered.
(a) The items of property to be considered in determining eligibility
are described in Sections 50425 through 50489. Each of these sections
indicates:
(1) Whether all or a portion of the item of property is exempt.
(2) The method for determining the net market value of the specific
item of property.
(3) Any other information necessary to evaluate the property.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Insututions
Code. Reference: Section 14006, Welfare and Institufions Code.
History
1. Change without regulatory effect adding NOTE filed 10-1 1-88 (Register 88,
No. 45).
§ 50425. Property Used As a Principal Residence.
(a) A principal residence may consist of real or personal property,
fixed or mobile, located on land or water. The principal residence in-
cludes land or buildings surrounding, contiguous to, or appertaining to
the residence.
(b) The following items of real property may serve as a principal resi-
dence:
(1) A house.
(2) The entire multiple unit dwelling if any portion of the multiple unit
dwelling serves as the principal residence of the applicant or benefici ary .
(3) The items listed in (d). These items shall be considered as real prop-
erty when they are assessed as real property by the county assessor of the
county in which the property is located.
(c) Property which the applicant or beneficiary uses or formerly used
as a home shall be exempt as the principal residence if any of the follow-
ing situations exist:
(1) The applicant or beneficiary lives on the property.
(2) The family of the applicant or beneficiary lives on the property and
Medi-Cal eligibility is determined in either of the following ways:
(A) With the applicant or beneficiary and the family in a single MFBU.
(B) With the income of the family considered in determining the appli-
cant's or beneficiary's eligibility.
(3) The applicant or beneficiary is absent from the property for any rea-
son, including admittance to LTC, and declares in writing that he/she in-
tends to return to the property to live.
(4) The applicant or beneficiary is absent from the property and has a
spouse, child under age 2 1 or a dependent relative, who lives on the prop-
erty. A disabled child age 21 or older is considered a dependent relative
for purposes of this regulation only.
(5) A sibling or child age 21 or over of the applicant or beneficiary has
continuously resided on the property for at least one year immediately
prior to the date the applicant or beneficiary entered a SNF or ICF and
continues to reside there.
(6) The property cannot be sold because there are legal obstacles pre-
venting the sale and the applicant or beneficiary or person acting on his/
her behalf provides evidence of attempts to overcome such obstacles.
(7) The applicant or beneficiary no longer lives on the property, does
not intend to return to the property, the property is not otherwise exempt
and the property cannot be readily converted to cash but a bona fide effort
is being made to sell the property. A bona fide effort to sell means that
the property is listed for sale with a licensed real estate broker for its fair
market value established by a qualified real estate appraiser, a good faith
effort is being made to sell the property, offers at fair market value are
accepted, and the applicant or beneficiary has supplied proof of com-
pliance with these condifions to the county.
Page 355
Register 95, No. 14; 4-7-95
§ 50426
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
(d) The following items of personal property may serve as a principal
residence:
(1) A mobile home.
(2) A houseboat.
(3) A motor vehicle used as a residence.
(4) Any other shelter not attached to the land and used as a residence.
(e) Only one property may be exempt as the principal residence.
(0 Real property formerly used as a principal residence shall be con-
sidered other real property, effective the first of the month following the
date the property is no longer used as a principal residence as specified
in (a). Such property shall be subject to all conditions placed upon other
real property in these regulations.
(g) Personal property formerly used as a principal residence shall be
evaluated as an item of personal property beginning the first of the month
following the date the property is no longer used as a principal residence
as specified in (c).
NOTE: Authority cited: Sections 10725, 14006.1 and 14124.5, Welfare and Insti-
tutions Code. Reference: Section 14006, Welfare and Institutions Code.
History
1 . Amendment filed 12-2-85 as an emergency; effective upon filing (Register 85,
No. 50). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 4-1-86. For prior history, see
Register 84, No. 51.
2. Certificate of Compliance including amendment of subsections (a)-(c) trans-
mitted to OAL 3-31-86 and filed 4-30-86 (Register 86, No. 18).
3. Change without regulatory effect of subsection (g) (Register 87, No. 11).
§ 50426. Property Used to Purchase a Principal Residence.
(a) The proceeds from the sale of real property retained by an applicant
or beneficiary who does not own a suitable principal residence or who
wishes to sell the current principal residence and purchase a new princi-
pal residence shall be exempt for a period of six months from the date of
receipt of the proceeds so long as the proceeds from the sale of the real
property are intended to be used to purchase a principal residence. Such
proceeds may also be applied to the costs of moving, necessary furnish-
ings, and repair or alteration to the principal residence.
(b) If a portion of the proceeds specified in (a) is diverted to some other
purpose, the status of the remainder is not affected provided such remain-
der is being retained to apply toward the purchase of a principal resi-
dence.
NOTE: Authority cited: Sections 10725, 14006.1 and 14124.5, Welfare and Jnsfi-
tutions Code. Reference: Section 14006, Welfare and Institutions Code.
History
1 . Amendment filed 12-15-77; effective thirtieth day thereafter (Register 77, No.
51).
2. Amendment filed 1 2-2-85 as an emergency; effective upon filing (Register 85,
No. 50). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 4-1-86.
3. Certificate of Compliance transmitted to OAL 3-31-86 and filed 4-30-86
(Register 86, No. 18).
§ 50427. Other Real Property.
(a) Real property not exempt as a principal residence, including deeds
of trust as specified in Section 50441(b), is other real property.
(b) Other real property not exempt under any other section of these
regulations shall be exempt if both of the following conditions are met:
(1) The combined net market value of all other real property is $6,000
or less.
(2) The owner meets the utilization requirements set forth in Section
50416.
(c) Other real property with a net market value of more than $6,000
shall be considered as follows:
(1) The first $6,000 of net market value shall be exempt if the owner
meets the utilization requirements set forth in Section 50416.
(2) The net market value in excess of $6,000 shall be included in the
property reserve.
NOTE; Authority cited: Sections 10725, 14006.1 and 14124.5, Welfare and Insfi-
tutions Code; Section 57(c), Chapter 328, Statutes of 1982; Section 87, Chapter
1594, Statutes of 1 982. Reference: Sections 1 1 153.7 and 14006, Welfare and Insti-
tutions Code.
History
1. Amendment filed 12-2-85 as an emergency; effecfive upon filing (Register 85,
No. 50). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 4-1-86. For prior history, see
Register 84, No. 51.
2. Certificate of Compliance transmitted to OAL 3-31-86 and filed 4-30-86
(Register 86, No. 18).
§ 50428. Liens.
(a) The Department shall record a lien against the ownership interest
in the principal residence of an institutionalized beneficiary if the proper-
ty meets the provisions of Section 50425 (a)(7) unless:
(1) The individual did not receive a Notice of Action according to the
provisions of Section 50179 or has not had the opportunity for a state
hearing according to the provisions of Article 18 (commencing with Sec-
tion 50951) of this Chapter. Such Notice shall include the following:
(A) The beneficiary has stated he/she does not intend to return to the
principal residence from long term care;
(B) A lien will be recorded against the property for the cost of all
Medi-Cal claims paid or to be paid on the beneficiary's behalf.
(C) The recording of the lien does not mean ownership of the property
is lost or transferred.
(D) The requirements to list the property for sale that the applicant or
beneficiary must meet to remain eligible for Medi-Cal in accordance
with Section 50425.
(E) The beneficiary has the right to a county level review and a state
hearing prior to recording of the lien or imposing any requirements to list
the property for sale.
(F) The procedures for requesfing a county level review and the time
limits within which such requests must be made.
(b) Any recorded lien for an amount equal to the cost of medical care
provided may be foreclosed only after one of the following:
(1) The beneficiary sells the property.
(2) The beneficiary dies and the following conditions are met:
(A) There is no surviving spouse.
(B) The beneficiary has no surviving child who is under the age of 21
or who is blind or disabled.
(c) Any lien shall dissolve when the beneficiary is discharged from
LTC and returns to the principal residence to live.
(d) The county department shall notify the Department upon a deter-
mination that:
(1) All the criteria set forth in Section 50428(a) are met; or
(2) A person in long term care has been discharged and has returned
to the principal residence to live.
NOTE: Authority cited: Sections 10725, 14006.1 and 14124.5, Welfare and Insfi-
tutions Code: Section 57(c), Chapter 328, Statutes of 1982; and Section 87, Chap-
ter 1594, Statutes of 1982. Reference: Section 14006, Welfare and Institutions
Code.
History
1. New section filed 12-31-82 as an emergency; effective upon filing (Register
83, No. 2). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 4-30-83.
2. Certificate ofCompHance including editorial correction of subsection (b)(1)(B)
transmitted to OAL 4-29-83 and filed 6-3-83 (Register 83, No. 23).
3. Editorial correction of subsection (b)(1)(B) refiled 7-6-83 (Register 83, No.
28).
4. Repealer filed 7-24-84 as an emergency; effecfive upon filing (Register 84, No.
31). A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on 1 1-21-84.
5 . Order of Repeal of 7-24-84 emergency order filed 1 2-20-84 by OAL pursuant
to Government Code Section 1 1349.6 (Register 84, No. 51).
6. Amendment filed 12-2-85 as an emergency; effective upon filing (Register 85,
No. 50). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 4-1-86.
) and filed 4-30-86
7. Certificate of Compliance transmitted to OAL 3-31-
(Register 86, No. 18).
Page 356
Register 95, No. 14; 4-7-95
Title 22
Health Care Services
§ 50433
•
§ 50429. Value and Division of Real Property Where Part Is
Used As a Home.
NOTE: Authority cited: Sections 10725, 14006.1 and 14124.5, Welfare and Insti-
tutions Code. Reference: Section 14006, Welfai^e and Institutions Code.
History
1 . Repealer filed 7-24-84 as an emergency; effective upon filing (Register 84, No.
31 ). A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on 11-21-84.
2. Order of Repeal of 7-24-84 emergency order filed 12-20-84 by OAL pursuant
to Government Code Section 1 1349.6 (Register 84, No. 51 ).
3. Repealer filed 1 2-2-85 as an emergency; effective upon filing (Register 85, No.
50). A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on 4-1-86.
4. Certificate of Compliance transmitted to OAL 3-31-86 and filed 4-30-86
(Register 86, No. 18).
§ 50431 . Land Contiguous to the Home — Value and
Division.
NOTE: Authority cited: Sections 10725, 14006.1 and 14124.5, Welfare and Insd-
tutions Code. Reference: Secfion 14006, Welfare and Institutions Code.
History
1 . Repealer filed 7-24-84 as an emergency; effective upon filing (Register 84, No.
31). A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on 11-21-84.
2. Order of Repeal of 7-24-84 emergency order filed 1 2-20-84 by OAL pursuant
to Government Code Section 1 1349.6 (Register 84, No. 51).
3. Repealer filed 1 2-2-85 as an emergency; effective upon filing (Register 85, No.
50). A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on 4-1-86.
4. Certificate of Compliance transmitted to OAL 3-31-86 and filed 4-30-86
(Register 86, No. 18).
§ 50433. Single Family Dwelling Used in Part As a
Business — Value and Division.
NOTE: Authority cited: Sections 10725, 14006.1 and 14124.5, Welfare and Insti-
tufions Code. Reference: Section 14006, Welfare and Insfitutions Code.
History
1 . Repealer filed 7-24-84 as an emergency; effective upon filing (Register 84, No.
31). A Certificate of Compliance must be transinitted to OAL within 120 days
or emergency language will be repealed on 11-21-84.
•
[The next page is 357.]
•
Page 356.1
Register 95, No. 14; 4-7-95
Title 22
Health Care Services
§ 50446
•
•
2. Order of Repeal of 7-24-84 emergency order filed 12-20-84 by OAL pursuant
to Government Code Section 11349.6 (Register 84, No. 51).
3. Repealer filed 1 2-2-85 as an emergency; effective upon filing (Register 85, No.
50). A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on 4-1-86.
4. Certificate of Compliance transmitted to OAL 3-31-86 and filed 4-30-86
(Register 86, No. 18).
§ 50435. Multiple Dwelling Unit — Value and Division.
NOTE: Authority cited: Sections 10725, 14006.1 and 14124.5, Welfare and Insti-
tutions Code. Reference: Section 14006, Welfare and Institutions Code.
History
1 . Repealer filed 7-24-84 as an emergency; effective upon filing (Register 84. No.
31). Certificate of Compliance must be transmitted to OAL within 120 days or
emergency language will be repealed on 1 1-21-84.
2. Order of Repeal of 7-24-84 emergency order filed 1 2-20-84 by OAL pursuant
to Government Code Section 1 1 3^49 .6 (Register 84, No. 51).
3. Repealer fi led 1 2-2-85 as an emergency; effecdve upon filing (Register 85, No.
50), A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on 4-1-86.
4. Certificate of Compliance transmitted to OAL 3-31-86 and filed 4-30-86
(Register 86, No. 18).
§ 50437. Land with More Than One Building — Value and
Division.
NOTE: Authority cited; Secfions 10725, 14006.1 and 14124.5, Welfare and Insti-
tutions Code. Reference: Section 14006, Welfare and Institutions Code.
History
1. Repealer filed 7-24—84 as an emergency; effecdve upon filing (Register 84, No.
31). A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on 1 1-21-84.
2. Order of Repeal of 7-24-84 emergency order filed 12-20-84 by OAL pursuant
to Government Code Section 1 1349.6 (Register 84, No. 51).
3. Repealer filed 12-2-85 as an emergency ; effective upon filing (Register 85, No.
50). A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on 4-1-86.
4. Certificate of Compliance transmitted to OAL 3-31-86 and filed 4-30-86
(Register 86, No. 18).
§ 50441 . Mortgages, Deeds of Trust and Other Promissory
Notes.
(a) Mortgages, notes secured by deeds of trust and other promissory
notes which can be sold or discounted shall be included in the property
reserve, except as specified in (b).
(b) A mortgage, or a note secured by a deed of trust, from the sale of
real property owned by the applicant or beneficiary shall be considered
other real property and subject to all the conditions placed upon other real
property in these regulations.
(c) The market value of all mortgages and notes shall be the value as
established in (1), unless the applicant or beneficiary chooses to meet the
conditions of (2), and (2) is lower:
(1) The principal amount remaining on the note.
(2) The appraised value obtained by the applicant or beneficiary from
a party qualified to appraise such items. Parties qualified to appraise such
items include, but are not limited to, any of the following:
(A) Banks.
(B) Savings and Loan Associations.
(C) Credit Unions.
(D) Licensed loan or mortgage brokers.
(d) Proceeds from mortgages and notes shall be considered as follows:
(1) The principal portion of the payment shall be treated as property.
(2) The interest portion of the payment shall be unearned income and
shall be included in determining the share of cost.
Note: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14006, Welfare and Institutions Code.
History
1. New section filed 5-6-81; effective thirtieth day thereafter (Register 81, No.
19). For prior history, see Registers 81, No. 15; 80, No. 48; 77, No. 51; 77, No.
17;and77, No. 5.
2. Editorial correcfion of NOTE filed 1-21-83 (Register 83, No. 4).
§ 50442. Life Estate.
(a) A life estate interest in real property shall be considered real proper-
ty-
(b) A life estate interest in personal property shall be considered per-
sonal property.
(c) The value of a life estate shall be:
(1) The entire market value of the property on which the life estate is
held if the applicant or beneficiary was the owner of the property prior
to selling the property and he/she is retaining a life estate interest in the
properly, and the Life estate is revocable, or
(2) In all other instances, the value determined in accordance with the
California State Gift Inheritance Tax Formula or, at the applicant's or
beneficiary's option, a lesser value established by a person qualified to
appraise such items as described in Section 50441 (c) (2).
NOTE: Authority cited: Sections 10725 and 14124.5. Welfare and Institutions
Code. Reference: Section 14006, Welfare and Institutions Code; and 42 United
States Code Section 1396a (a) (10) (C).
History
1 . Editorial con-ection adding NOTE filed 6-10-83 (Register 83, No. 24).
2. Amendment of subsection (c) filed 5-17-89; operative 6-16-89 (Register 89,
No. 20).
§ 50443. American Indian's Interest in Land Held in Trust
by United States Government.
The entire market value of an American Indian's interest in land held
in trust by the United States Government shall be exempt.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institudons
Code. Reference: Section 14006, Welfare and Institutions Code.
History
1. Change without regulatory effect adding NOTE filed 10-11-88 (Register 88,
No. 45).
§ 50445. Federal Payments to Indians and Alaskan
Natives — Property.
(a) Payments received from the Federal Government under Public
Law 90-507 shall be excluded from consideration as personal property
when the total of nonexempt personal property, including such payments
does not exceed $2,000 for each individual. Payments converted into oth-
er property shall be treated the same as the payments. However, if the
property received through such a conversion is again converted, the
property acquired is included in the property reserve unless otherwise ex-
empt.
(b) Payments received from the Federal Government under Public
Law 92-254 or Section 6 of Public Law 87-775 shall be exempt.
(c) Per capita payments distributed pursuant to any judgment of the In-
dian Claims Commission or the Court of Claims in favor of any Indian
Tribe are exempt.
(d) Shares of stock and money payments made to Alaskan Nafives un-
der the Alaskan Native Claims Settlement Act are exempt as long as the
payments or stock remain separately identifiable and not comingled with
nonexempt resources. Any property obtained from stock investments un-
der the Act is not exempt.
(e) Receipts derived from lands, as specified in Section 50537(e), shall
be exempt providing all of the following conditions are met. The monies:
(1) Are retained by the original recipient.
(2) Are not commingled.
(3) Can be separately identified as a proportionate share of the appli-
cant's or beneficiary's property.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Insdtutions
Code. Reference: Section 14006, Welfare and Institutions Code.
History
1. New subsection (e) filed as an emergency 6-17-80; (Register 80, No. 25). A
Certificate of Compliance must be transmitted to OAL within 1 20 days or emer-
gency language will be repealed on 10-16-80.
2. Certificate of Compliance filed 9-26-80 (Register 80, No. 39).
§ 50446. Payments to Victims of the National Socialist
Persecution.
(a) Payments received from the Federal Republic of Germany (Ger-
man Reparations Payments) pursuant to the federal law on the Compen-
sation of Victims of the National SociaUst Persecution (Federal Compen-
Page 357
Register 98, No. 14; 4-3-98
§ 50448
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
sation Law) shall be exempt from consideration as personal property pro-
vided these funds are not spent and are kept identifiable.
(b) If the funds referred to in subsection (a) have been spent, the prop-
erly acquired with the funds shall be included in the property reserve un-
less otherwise exempt.
(c) If the exempt funds referred to in subsection (a) have been com-
mingled with nonexempt funds, it is the applicant's or beneficiary's re-
sponsibility to be able to distinguish which are the exempt commingled
funds. It is presumed that withdrawals from an account in which exempt
and nonexempt funds have been commingled were made from the nonex-
empt fund first.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 1 4005.5 and 14006, Welfare and Institutions Code, and
Program Operations Manual SI 01120.405.
History
1. New section filed 9-4-91; operative 10-4-91 (Register 92, No. 2).
2. Editorial correction of subsection (c) (Register 95, No. 45).
§ 50448. Payments to Victims of Crimes — Treatment as
Property.
Payments made under the California Victims of Crimes program,
which are exempt as income in the month of receipt in accordance with
Section 50534, shall be exempt as property for the 9-month period begin-
ning after the month in which the payment was received.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; Sections 1383(a)(9), 1382b(a) and 1396a(r), Title 42, United States Code.
Reference: Section 13959, Government Code; Section 14006(c), Welfare and In-
stitutions Code.
History
1. New section filed lO^t-93; operafive 1 1-3-93 (Register 93, No. 41).
§ 50448.5. Relocation Assistance Benefits.
(a) Relocation assistance benefits are payments made by a public
agency to a person who has been relocated as a result of a program of area
redevelopment, urban renewal, freeway construction, or any other public
development involving demolition or condemnation of existing housing.
(b) Relocation Assistance Benefits paid by a public agency shall be ex-
empt provided these these funds are not spent and are kept identifiable.
(c) If the exempt funds referred to in subsection (b) have been com-
mingled with nonexempt funds, it is the applicant's or beneficiary's re-
sponsibility to be able to distinguish which are the exempt commingled
funds. It is presumed that withdrawals from an account in which exempt
and nonexempt funds have been commingled were made from the nonex-
empt funds first.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 1396a(r)(2) and 4636, Title 42, United States Code;
Sections 14005.4, 14005.7 and 14006, Welfare and Institutions Code; and United
States Department of Health and Human Services Social Security Administration
"Program Operations Manual SI 00830.655, SI 01130.670 and SI 01130.700."
History
1. New section filed 3-30-98; operafive 4-29-98 (Register 98, No. 14).
§ 50449. Earned Income Tax Credit.
The actual Earned Income Tax Credit (EITC) payment or an advance
payment of the Earned Income Tax Credit made by an employer shall be
exempt in the month following the month of receipt.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Insfitufions
Code. Reference: Section 14006, Welfare and Institutions Code; Sections 1612b,
161 3a and 1 902r(2), Social Security Act [42 U.S.C. Secfions 1382a(b), 1382b(a),
and 1396a(r)(2)].
History
1. New secdon filed 2-2-93; operafive 3-4-93 (Register 93, No. 6).
§50451. Cash on Hand.
Cash on hand shall be included in the property reserve, unless it is in-
come received in that month.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Insfitufions
Code. Reference: Secfion 14006, Welfare and Insfitufions Code.
History
1. Change without regulatory effect adding NOTE filed 10-1 1-88 (Register 88,
No. 45).
§ 50453. Checking and Savings Accounts.
(a) The enfire amount in checking and savings accounts to which the
applicant or beneficiary has unrestricted access shall be included in the
property reserve, subject to the limitations in Section 50453.5 and the fol-
lowing conditions:
(1) Income received during a month and deposited in a checking or
savings account shall not be considered as property during that month.
(2) Accounts held with persons who are not family members shall be
considered available in their entirety if the applicant or beneficiary has
unrestricted access to the funds, unless the conditions of (3) are met.
(3) If the applicant or beneficiary presents evidence which clearly esta-
blishes that all or a portion of the funds specified in (2) are the property
of a person who is not a family member, those funds shall not be consid-
ered the property of the applicant or beneficiary.
(b) If an applicant or beneficiary has restricted access to a checking or
savings account such as accounts which require two signatures or savings
accounts held in trust by other than the applicant or beneficiary, only
those funds actually available shall be included in the properl:y reserve.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Insfitutions
Code. Reference: Secfion 14006, Welfare and Insfitufions Code.
History
1. Amendment filed 3-7-80; effecfive thirtieth day thereafter (Register 80, No. 9).
§ 50453.5. Savings of a Child.
Reasonable amounts saved from a child's exempt earnings for future
education or for other future identifiable needs are exempt as property.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Insfitufions
Code. Reference: Section 14006, Welfare and Institufions Code.
History
1 . New secfion filed 3-7-80; effective thirtieth day thereafter (Register 80, No. 9).
§ 50453.7. Long-Term Care Insurance Exemption.
(a) Property shall be exempt up to the amount of benefits that have
been paid for Long-Term Care services countable towards the Medi-Cal
property exempfion as defined in Secdon 58023 in behalf of the Medi-
Cal applicant or Medi-Cal beneficiary under a cerfified long-term care
insurance policy or certificate certified by the State to provide this ex-
emption.
(b) Property exempted under subsection (a) shall also be exempt from
any recovery by the State of payments made for medical services.
(c) Income received from property exempt under subsection (a) shall
be nonexempt and shall be treated in accordance with regulations con-
tained in Article 10 of Chapter 8.
(d) The Medi-Cal applicant or Medi-Cal beneficiary shall provide
verificafion from the insurance company of the amount of qualified bene-
fits paid which entitle that applicant or beneficiary to an exemption under
subsecfion (a). After notifying the Department in accordance with Pro-
bate Code, Sections 215 and 9202, the person handling the estate of a de-
ceased Medi-Cal beneficiary shall also provide verification to the De-
partment from the insurance company of the amount of qualified benefits
paid which entitle that deceased beneficiary to an exemption under sub-
secfion (b).
(1) If the verificafion provided by the insurance company is found to
be in error resulfing in the ineligibility of the Medi-Cal applicant or
Medi-Cal beneficiary, the County shall nofify the Department to take ap-
propriate actions against the insurance company under Secfion 58082(e).
(2) If the verificafion provided by the insurance company is found to
be in such a condition that the County cannot determine whether the
Medi-Cal applicant or Medi-Cal beneficiary is entitled to an exemption
under subsection (a), the County shall determine that the Medi-Cal appli-
cant or Medi-Cal beneficiary is not enfitied to such an exempfion and
shall nofify the Department to take appropriate actions against the insur-
ance company under Section 58082(f) of the Partnership Regulations for
Insurers.
(3) If the verification provided to the Department by the person handl-
ing the estate of a deceased beneficiary is found to be either in error, or
Page 358
Register 98, No. 14; 4-3-9
Title 22
Health Care Services
§ 50459
in such a condilion that the Department cannot determine whether the de-
ceased beneficiary is entitled to an exemption under subsection (b), the
Department shall take appropriate actions against the insurance company
under Section 58082(e) and (f).
NOTE: Authority cited: Section 22009(a), Welfare and Institutions Code. Refer-
ence: Sections 22004, 22005 and 22006, Welfare and Institutions Code.
History
1. New section filed 11-1-93 as an emergency; operative 1 1-1-93 (Register 93,
No. 45). A Certificate of Compliance must be transmitted to OAL by 3-1-94
or emergency language will be repealed by operation of law on the following
day.
2. Certificate ofCompliance as to 11-1-93 order including amendment of subsec-
tion (d)(3) transmitted to OAL 2-17-94 and filed 3-31-94 (Register 94, No.
13).
3. Editorial correction of printing errors in subsections (a), (d) and (d)(2) (Register
94, No. 13).
§ 50454. Income Tax Refunds.
Income tax refunds shall be included in the property reserve.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14006, Welfare and Institutions Code.
History
1. Editorial correction adding NOTE filed 6-10-83 (Register 83, No. 24).
§ 50454.5. California Franchise Tax Board Payments.
(a) The following payments or funds received from the California
Franchise Tax Board shall be exempt:
(1) Renters Credits.
(2) Senior Citizens Homeowners and Renters Property Assistance.
(3) Senior Citizens Tax Postponement.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Insdtufions
Code, Reference: Section 11008.4, Welfare and Institufions Code.
History
1. New section filed 4-17-89; operative 5-17-89 (Register 89, No. 48) .
§ 50455. Lump Sum Payments.
(a) Nonrecurring lump sum social insurance payments, such as nonre-
curring lump sum payments of any of the items specified in section
50507(a)(1) through (9), shall be included in the property reserve, except
as provided in (b).
(b) Retroactive SSI and Title II benefit payments shall not be included
in the property reserve for a period of six months after the month in which
they are received.
(c) The provisions of this regulation also apply to eligibility determi-
nations or redeterminations made retroactively to October 1. 1984.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4, 14005.7, 14005. Sand 14006, Welfare and In-
stitutions Code.
History
1. Editorial correction adding NOTE filed 6-10-83 (Register 83, No. 24).
2. Amendment filed 4—15-85 as an emergency; effective upon filing (Register 85,
No. 16). A Certificate ofCompliance must be transmitted to OAL within 120
days or emergency language will be repealed on 8-13-85.
3. Certificate ofCompliance as to 4-1 5-85 order transmitted to OAL 8-1 3-85 and
filed 9-18-85 (Register 85, No. 38).
4. Change without regulatory effect amending subsection (a) filed 6-14-91 pur-
suant to section 100, title 1, California Code of Regulations (Reeister 91, No.
35).
§ 50456. Stocks, Bonds, Mutual Funds.
Stocks, bonds and mutual funds shall be included in the property re-
serve. The value of these items shall be the closing price on the date the
property is evaluated.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and InsUtutions
Code. Reference: Section 14006, Welfare and Institutions Code.
History
1. Change without regulatory effect adding NOTE filed 10-1 1-88 (Register 88,
No. 45).
§ 50457. United States Savings Bonds.
United States Savings Bonds shall be included in the property reserve.
The value of these bonds shall be the amount for which they can be sold.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14006, Welfare and Institutions Code.
History
1. Change without regulatory effect adding NOTE filed 10-1 1-88 (Register 88,
No. 45).
§ 50459. Promissory Notes.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and InsUtutions
Code. Reference: Section 14006, Welfare and Institutions Code.
•
[The next page is 359.]
Page 358.1
Register 98, No. 14; 4-3-98
Title 22
Health Care Services
§ 50471
•
•
History
1 . Amendment filed 12-15-77; effective thirtieth day thereafter (Register 77, No.
31).
2. Repealer filed 1 1-26-80 as an emergency; effective upon filing (Register 80,
No. 48). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 3-26-81.
3. Certificate of Compliance transmitted to OAL 3-9-81 and filed 4-7-81 (Regis-
ter 81, No. 15).
§50461. Motor Vehicles.
(a) One motor or other vehicle that is used for transportation shall be
exempt, subject to the following conditions:
(1) The applicant or beneficiary shall be allowed to choose which ve-
hicle used for transportation shall be exempt except that recreational and
commercial vehicles shall be considered to be used for transportation
only if other motor vehicles are not available to provide transportation for
the applicant or beneficiary.
(2) A vehicle owned by an applicant or beneficiary who no longer
drives shall be exempt when other individuals use the vehicle to meet the
transportation needs of the applicant or beneficiary.
(b) The net market value of all nonexempt motor vehicles shall be in-
cluded in the property reserve.
(c) The net market value of a motor vehicle shall be determined by the
following process:
(1) Determine the class of the motor vehicle.
(2) Determine the vehicle license fee which does not include registra-
tion or weight fees, using the class and the State Department of Motor Ve-
hicles license fee chart.
(3) Multiply the vehicle license fee by 50. This is the market value of
the motor vehicle.
(4) Subtract any encumbrances of record from the market value. This
is the net market value.
(d) In those cases where the class of the motor vehicle is unknown or
unavailable, the county department or the applicant or beneficiary shall
contact the State Department of Motor Vehicles to determine the class or
license fee of the motor vehicle.
(e) In those cases where the applicant or beneficiary does not agree
with the net market value:
(1) Three appraisals by auto dealers, insurance adjustors or personal
property appraisers shall be submitted to the county department.
(2) The average of these appraisals shall be the market value.
(3) The net market value shall be the market value minus any encum-
brances of record.
NOTE; Authority cited: Secfions 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4 and 14005.7, Welfare and Institutions Code.
History
1. Amendment of subsection (d)and new subsection (e) filed 12-15-77; effective
thirtieth day thereafter (Register 77, No. 51).
2. Amendment of subsections (a)(1) and (d) filed 8-8-80; effective thirtieth day
thereafter (Register 80, No. 32).
§ 50463. Boats, Campers, Trailers.
(a) The net market value of boats, campers, and trailers and mobile
homes, which are not assessed as real property by the county assessor,
shall be included in the property reserve unless exempt as either of the
following:
(1) A principal residence.
(2) A vehicle used for transportation.
(b) Items in (a) which are assessed as real property by the county asses-
sor of the county in which the property is located and which are not ex-
empt as a home shall be considered as other real property and treated in
accordance with Section 50427.
(c) The net market value of these items shall be determined as follows:
(1) The market value shall be any of the following:
(A) The average of three appraisals by dealers, insurance adjustors or
personal property appraisers submitted to the county department by the
applicant or beneficiary.
(B) The market value placed on the item by the county assessor.
(C) The market value of the item determined by use of the State De-
partment of Motor Vehicle's license fee chart.
(D) The original purchase price of the item if the applicant or benefi-
ciary does not wish or is unable to provide three appraisals or the market
value cannot be determined in accordance with (B) or (C).
(2) The net market value shall be the market value less any encum-
brances of record.
(d) Eligibility or share-of-cost determinations effective on or after
January 1, 1980, shall be based on the provisions of this section.
NOTE: Authority cited: Sections 10725, 14006.1 and 14124.5, Welfare and insti-
tufions Code. Reference: Section 14006, Welfare and Institutions Code.
History
1. Amendment of subsection (b)(1) filed 1 2-1 5-77; effective thirtieth day thereaf-
ter (Register 77, No. 51).
2. Amendment filed 3-7-80 as an emergency; effective upon filing (Register 80,
No. 9). A Certificate of Compliance must be transmitted to OAH within 120
days or emergency language will be repealed on 7-6-80.
3. Certificate of Compliance filed 6-6-80 (Register 80, No. 23).
4. Amendment of subsection (a)( 1 ) filed 1 2-2-85 as an emergency; effective upon
filing (Register 85, No. 50). A Certificate of Compliance must be transmitted
to OAL within 120 days or emergency language will be repealed on 4—1-86.
5. Certificate of Compliance transmitted to OAL 3-31-86 and filed 4-30-86
(Register 86, No. 1 8).
§ 50465. Household Items.
All items used to furnish and equip a home shall be exempt.
NOTE; Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14006, Welfare and Institutions Code.
History
1. Editorial con-ection adding NOTE filed 6-10-83 (Register 83 No. 24).
§ 50467. Personal Effects.
(a) All iteins of clothing shall be exempt.
(b) The following jewelry shall be exempt:
(1) Wedding and engagement rings.
(2) Heirlooms.
(3) Any other item of jewelry with a net market value of $100 or less.
(c) The net market value of jewelry not exempted above shall be in-
cluded in the property reserve.
(d) The net market value of jewelry shall be determined as follows:
(1) The applicant or beneficiary shall submit at least one written ap-
praisal of current market value by a jeweler, insurance adjuster or person-
al property appraiser, or proof of the purchase price in the form of a sales
slip which shall estabhsh the market value.
(2) Subtract any encumbrances of record from the market value. This
is the net market value.
NOTE; Authority cited: Secfions 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14006, Welfare and Institutions Code; and 42 CFR
435.851.
History
1. Amendment of subsection (d) filed 8-18-82 as an emergency; effective upon
filing (Register 82, No. 34). A Certificate of Compliance must be transmitted
to OAL within 120 days or emergency language will be repealed on 12-16-82.
2. Certificate of Compliance u-ansmitted to OAL 12-14-82 and filed 1-21-83
(Register 83, No. 4).
3. Editorial con-ecfion of NOTE filed 6-10-83 (Register 83, No. 24).
4. Amendment of subsection (d)(1) filed 10-24-86; effective thirtieth day thereaf-
ter (Register 86, No. 43).
§ 50469. Recreational Items.
(a) All recreational items shall be exempt, except for:
(1) Recreational motor vehicles, such as motor homes and snowmo-
biles, which shall be considered in accordance with Section 50461.
(2) Boats, campers and trailers, which shall be considered in accor-
dance with Section 50463.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14006, Welfare and Institutions Code.
History
1. Editorial correction adding NOTE filed 6-10-83 (Register 83, No. 24).
§ 50471. Musical Instruments.
All musical instruments shall be exempt.
Page 359
Register 97, No. 15; 4-11-97
§ 50473
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
NOTE; Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14006, Welfare and Institutions Code.
History
I . Editorial correction adding NOTE filed 6-10-83 (Register 83, No. 24).
§ 50473. Livestock and Poultry.
(a) Livestock and potiltry retained primarily for personal use shall be
exempt.
(b) The net market value of livestock and poultry retained primarily
for profit shall be included in the property reserve except to the extent ex-
empt as business property in accordance with Section 5)0485.
(c) The net market value of livestock and poultry shall be the net inar-
ket value listed by the applicant or beneficiary on the Statement of Facts,
unless the county department determines further verification is required.
If verification is required:
(1) The applicant or beneficiary shall submit three appraisals from per-
sons or businesses dealing in livestock and poultry. The average of these
appraisals shall be the market value.
(2) Subtract any encumbrances of record from the market value. This
is the net market value.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 12305 and 12305.5, Welfare and Institutions Code.
History
1. Amendment of subsection (b) filed 5-17-79 as an emergency; effective upon
filing (Register 79, No. 20).
2. Certificate of Compliance filed 9-12-79 (Register 79, No. 37).
§ 50475. Life Insurance.
Life insurance policies, except term insurance, owned by a member of
the MFBU on the life of any individual in the fainily shall be exempt if
the combined face value of all of the policies on the insured individual
is $ 1 ,500 or less. If the combined face value of all of the policies exceeds
$1,500, the net cash surrender value of life insurance policies shall be in-
cluded in the property reserve.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14006, Welfare and Institutions Code.
History
1. Amendment filed 6-3-87; operative 7-3-87 (Register 87, No. 24).
2. Editoinal correction of printing error (Register 89, No. 16).
§ 50476. Burial Insurance.
Burial insurance with no cash surrender value shall be exempt. Burial
insurance with a cash .surrender value shall be considered a revocable
burial fund and shall be treated as provided for in section 50479.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 11158, 12152 and 14006. Welfare and Institutions
Code; and Section 416.1231, Title 20, Code of Federal Regulations.
History
1. New section filed 3-7-80 as an emergency; effective upon filing (Register 80,
No. 9). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 7-6-80.
2. Certificate of Compliance filed 6-6-80 (Register 80, No. 23).
3. Amendment filed 5-29-91; operafive 6-28-91 (Register 91, No. 31).
§ 50477. Burial Plots, Vaults and Crypts.
(a) Any burial plot, vault or crypt retained by the applicant or benefi-
ciary for use by any member of the family shall be exempt. For the pur-
poses of this section only, the family shall include the applicant or benefi-
ciary, his/her spouse, adult or minor children (including adopted and
stepchildren), siblings, parents, adoptive parents, and the spouses of
those individuals.
(b) The net market value of any burial plot not exempted above is other
real property and shall be subject to all conditions placed on other real
property in these regulations.
(c) The net market value of any burial vault or crypt not exempted
above is personal property and shall be included in the property reserve.
(d) The net market value of a burial plot, vault or crypt shall be the net
market value listed by the applicant or beneficiary on the Statement of
Facts, unless the county department determines further verification is re-
quired. If verification is required:
(1) The applicant or beneficiary shall submit a statement of value from
the organization from which the plot, vault or crypt was purchased. This
statement of value shall be the market value.
(2) Subtract encumbrances of record from the market value. This is the
net market value.
NOTE; Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 11158. 12152 and 14006, Welfare and Institutions
Code; and Section 416.1231, Title 20, Code of Federal Regulations.
History
1 . Editorial corrections adding NOTE filed 6-11-83 (Register 83, No. 24).
2. Amendment of subsection (a) filed .5-29-91 : operative 6-28-91 (Register 91,
No. 31).
§ 50479. Burial Funds.
(a) All of the following burial funds for an individual shall be exempt.
(1 ) Money or securities placed in an irrevocable trust for funeral, cre-
mation, or interment expenses with the following trustees: any banking
institution or trust company empowered by the State of California to act
as trustee in the handling of trust funds, cemetery authority which has es-
tablished an endowment care fund, or not less than three persons one of
whom may be in the employ of a funeral director.
(2) Money or securities placed in an irrevocable trust created by the
deposit in an insured savings institution made by one person of his or her
own money in his or her own name as trustee for a funeral director to pro-
vide payment for funeral services rendered by the funeral director upon
the depositor's death.
(3) Life or burial insurance purchased specifically for funeral, crema-
tion, or interment expense, which is placed in an irrevocable trust or
which has no loan or surrender value available to the recipient.
(4) Securities issued by a licensed ceinetery authority which by their
terms are convertible only into payment for funeral, cremation, or inter-
ment expenses.
(b) The first $1,500 paid for designated burial funds for funeral, cre-
mation or interment expenses for an individual shall be exempt when the
fund is revocable.
(c) Designated burial funds include burial trusts, prepaid burial con-
tracts, burial insurance, annuities or any separately identifiable assets
which are clearly designated as set aside for the expenses connected with
the individual's burial, cremaUon, or other funeral arrangements.
(d) Interest earned on or appreciation in value of either an exempt buri-
al fund described in subsection (a), above or revocable designated burial
fund described in subsections (b) and (c), above shall be exempt if it is
left to accumulate and become part of the separately identifiable burial
fund.
(e) The amount of designated burial funds which are not exempt shall
be included in the property reserve.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Institufions
Code. Reference: Secfions 11158 and 14006, Welfare and InsUtufions Code;
Secfion I396a(r)(2), Title 42, United States Code; and Secfions 416.1201 and
416.1231, Title 20, Code of Federal Regulafions.
History
1 . Amendment filed 3-7-80 as an emergency; effective upon filing (Register 80,
No. 9). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 7-6-80.
2. Certificate of Compliance filed 6-6-80 (Register 80, No. 23).
3. Amendment filed 5-29-91; operafive 6-28-91 (Register 91, No. 31).
4. Amendment of section heading, section and Note filed 10-25-95; operative
1 1-24-95 (Register 95, No. 43).
§ 50481 . Disaster and Emergency Assistance Payments.
Disaster and emergency assistance payments, regardless of the date of
receipt, and any interest eained from such payments, shall be permanent-
ly exempt and shall not be included in the property reserve. This exemp-
tion applies only to such payments received from federal, state, or local
government agencies, or disaster assistance organizations.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Insfitutions
Code. Reference: Section 14006, Welfare and Institutions Code; and 42 U.S.C.
Sections 1382a(b)(ll) and (12), 1382b(a)(6), 1396a(a)(10), 5121 et seq. and
5155(d).
History
1. New section filed 10-5-93; operative 1 1-4-93 (Register 93, No. 41).
2. Editorial correction of NOTE (Register 97, No. 15).
Page 360
Register 97, No. 15; 4-11-97
Title 22
Health Care Services
§ 50489
•
§ 50483. Loans.
(a) Loans shall be exempt as property in the month in which they are
any of the following:
(1) Exempt as income in accordance with Section 50533.
(2) Treated as income in the month of receipt because no repayment
is required.
(b) Loans which require repayment, except those exempted in (a)(1),
shall be included in the property reserve beginning in the month of re-
ceipt.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14006, Welfare and Institutions Code.
History
1 . Amendment filed 9-17-79 as an emergency: effective upon filing (Register 79,
No. 38). A Certificate of Compliance must be filed within 120 days or emergen-
cy language will be repealed on 1-15-80.
2. Certificate of Comphance transmitted to OAH 1-8-80 and filed 1-16-80 (Reg-
ister 80, No. 3).
§ 50485. Business Property.
(a) Equipment, inventory, licenses and materials owned by the appli-
cant or beneficiary which are necessary for employment, for self-support
or for an approved plan of rehabilitation or self-care necessary for em-
ployment shall be exempt.
(1) Equipment, inventory, licenses and materials shall be considered
necessary for employment if either of the following conditions is met:
(A) The applicant's or beneficiary's employer requires that the appli-
cant or beneficiary provide this property as a condition of employment.
(B) The applicant or beneficiary is currently unemployed but has been
required to use this property for employment in the past and can provide
reasonable evidence that the applicant or beneficiary is actively seeking
employment which will require the use of the same property. This prop-
erty shall be exempt for a maximum of one year from the date the benefi-
ciary became unemployed if this condition is met.
(2) Equipment, inventory, licenses and materials shall be considered
necessary for self-support if the applicant or beneficiary obtains a rea-
sonable rate of return from the use of this property.
(A) A business or means of self-support that has been in existence for
more than one year shall be considered to be realizing a reasonable rate
of return if it is earning an annual net income equal to six percent of the
net market value of the property. Net income shall be determined in ac-
cordance with Sections 50505 and 50517(a)(5).
(B) A business or means of self-support that has been in existence for
more than one year and is not earning net income equal to six percent of
the net market value of the property shall be considered to be providing
a reasonable rate of return for a maximum of six months if the applicant
or beneficiary can show by objective evidence that the property will be-
gin earning six percent within six months.
(C) A business or means of self-support shall not be required to realize
any actual income during the first year of operation in order to meet the
requirement for realizing a reasonable rate of return.
(D) A business or means of self-support that has been in existence for
more than one year and is resumed after an illness, or a period of con-
valescence from an illness or injury, shall not be required to realize any
actual income during the first six months of resumed operation in order
to meet the requirement for realizing a reasonable rate of return.
(E) A business or means of self-support that has provided the appli-
cant or beneficiary with income in the past shall be considered to be pro-
viding a reasonable rate of return for a maximum of one year during a pe-
riod when it is not in operation if the applicant or beneficiary can provide
evidence that both of the following conditions are met:
1 . The business or means of self-support is not in operation due to rea-
sons beyond the applicant's or beneficiary's control.
2. Operation will be resumed within one year of the date operation
ceased.
(3) Equipment, inventory, licenses and materials shall be considered
necessary for an approved plan of rehabilitation or self-care necessary
for employment if the county department determines that the property is
necessary for any of the following:
(A) Training which will lead to employment or self-support.
(B) Future employment or a means of self-support that will result from
a plan of rehabilitation established by the county or the Department of
Rehabilitation.
(C) Employment or a means of self-support that will continue after a
period of illness or a period of convalescence or both.
(b) Motor vehicles shall be considered equipment only if used for em-
ployment or for a means of self-support other than for commuting to and
from work.
(c) Cash on hand and money in checking accounts necessary for the
functioning of a business or a means of self-support shall be exempt up
to a maximum of three times the average monthly cash expenditures of
the business.
(d) Real property used in whole or in part as a business or as a means
of self-support shall be considered other real property in accordance with
Section 50427.
(e) Stocks, bonds and other similar items of personal property shall not
be considered property necessary for employment or self-support even
in those instances where the beneficiary holds stock in the corporation in
which the beneficiary is employed.
(f) A person who owns equipment, inventory, licenses and materials
for self-support shall not be required to be personally involved in the
business or means of self-support in order for the property to be exempt
under (a).
(g) The net market value of business equipment, inventory, licenses
and materials shall be the amount listed by the applicant or beneficiary
on the Statement of Facts, unless the county department determines that
Sections 50442 through 50489 provide a method of valuing the specific
item of property or that further verification is required.
(1) If any of the sections between Sections 50442 and 50489 can be
applied as a method of valuing the specific item of property that method
shall be used.
(2) If the county determines that further verification is required and
Sections 50442 through 50489 do not apply:
(A) The applicant or beneficiary shall submit an appraisal from an ap-
propriate dealer, insurance adjuster or personal property appraiser. The
value listed on the appraisal shall be the market value.
(B) The county shall subtract encumbrances of record from the market
value. This is the net market value.
NOTE; Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 11 155, 12305, 12305.5, and 14006, Welfare and Insti-
tutions Code.
History
1 . Amendment filed 5-17-79 as an emergency; effective upon filing (Register 79,
No. 20).
2. Certificate of Compliance filed 9-12-79 (Register 79, No. 37).
3. Amendment filed 1-16-80; effective thirtieth day thereafter (Register 80, No.
3).
§ 50487. Stocks Held by Natives of Alaska.
Shares of stock in a regional or village corporation held by natives of
Alaska for a 20 year period during which such stock cannot be conveyed,
transferred or surrendered, shall be exempt.
NOTE: Authority cited; Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14006, Welfare and InstituUons Code.
History
1. Editorial correcfion adding Note filed 6-1 1-83 (Register 83, No. 24).
§ 50489. Trusts— General.
(a) Property and income held in trust for the benefit of an individual
or individual's spouse shall be treated in accordance with Sections 50489
through Section 50489.9. These sections shall supersede any other sec-
tion(s) of this article.
(b) For purposes of sections 50489 through 50489.9, the following
definitions apply:
Page 361
Register 98, No. 5; 1-30-98
§ 50489.1
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
( J ) "Annuiiant" means a person who has the right to receive payments
from an annuity. The annuity shall be annuitized based upon the life ex-
pectancy of the annuitant.
(2) "Annuitized" means that an annuity is paying a fixed, equal
amount to the annuitant on a periodic basis. Payments shall be no less fre-
quent than monthly over a number of years equal to or less than the annu-
itant' s life expectancy as indicated in life expectancy tables provided by
the Secretary for the Department of Health and Human Services, con-
tained in Section 3258.9 (Revision 64), Part 3 of the Health Care Financ-
ing Administration's State Medicaid Manual and titled "Life Expectancy
Table — Males and Life Expectancy Table — Females". The final annuity
payment may be for an amount less than the previously fixed annuity
payments in order to fully exhaust benefits under the annuity. An annuity
shall be considered annuitized even though it may provide an annual cost
of living adjustment equal to or less than 5%.
(3) "Annuity" means a contract to make periodic payments of a fixed
or variable sum paid to an annuitant which are payable unconditionally.
Annuity payments may continue for a fixed period of time or for as long
as an annuitant lives. An annuitant purchases an annuity with his or her
property or property rights. Annuities shall be established to provide the
annuitant with payments representing principal and interest which are
more than the fair market value of the property used to purchase the annu-
ity. Annuities purchased prior to August 1 1, 1993, other periodic pay-
ment plans, or annuities that are purchased with property rights belong-
ing to someone other than the Medi-Cal applicant/beneficiary or spouse
shall continue to be treated in accordance with Title 22, Section 50402
and Article 10 of this chapter.
(4) "Assets" shall mean all income and property of the individual or
the individual's spouse, including income or property which the individ-
ual or spouse is entitled to, but does not receive because of circumstances
brought about by:
(A) the individual or the individual's spouse, or
(B) any other individual or entity, including a court or administrative
body, with legal authority to act in place of, or on behalf of, the individual
or the individual's spouse, or
(C) any other individual or entity, including any court or administra-
tive body, acting at the direction or upon the request of the individual or
the individual's spouse.
(5) "Beneficiary" means any individual or individuals designated in
the trust instrument as benefiting in some way from the trust.
(6) "Date of establishment" means the date the trust document (in the
case of a trust), annuity purchase agreement (in the case of an annuity),
or other creating document (in the case of a similar legal device) is signed
and dated. A trust is not considered to be established on the date it has
been amended.
(7) "Irrevocable trust" means a trust which cannot be revoked by its
own terms or a trust deemed to be irrevocable under State law.
(8) "Revocable trust" means a trust which can be revoked by its own
terms or a trust deemed to be revocable under State law.
(9) "Similar legal device" (SLD) means any legal instrument, device
or arrangement that involves the transfer of assets from an individual or
entity (transferor) to another individual or entity (transferee) with the in-
tent that the assets be held, managed, or administered by an individual or
entity for the benefit of the transferor or certain other individuals. SLDs
also include annuities purchased on or after August II, 1993.
(10) "Trust" means any arrangement in which an individual or entity
(trustor) transfers assets to a trustee with the intent that the assets be held,
managed, or administered by the trustee(s) for the benefit of the trustor
or certain designated individuals (beneficiaries). The trust must be valid
under State law. The term "trust" also includes any legal instrument or
device similar to a trust as described in subsection (b)(9) of this section.
(11) "Trustee" means any individual(s), entity, trust advisory commit-
tee, or individual(s) with power of appointment, who manages, holds, or
administers a trust for the trust beneficiary or beneficiaries.
( 1 2) "Trustor" means an individual who creates a trust. A trustor is also
known as the "settlor" or "grantor".
(c) For purposes of this article, trusts shall be classified in three ways:
(1) Medicaid Qualifying Trusts (MQT): A tmst established prior to
August 11. 1993, as described in Section 50489.1.
(2) OBRA 93 Trusts: A tmst established on or after August 11,1 993
as described in Section 50489.5.
(3) Other Trusts: A trust other than those described in subsections
(c)(1) or (c)(2) of this section.
(d) Placement of assets in. or distributions from, a trust other than a
burial trust which is exempt pursuant to Section 50479 shall be consid-
ered a transfer of assets.
(e) Verification of trusts shall be performed by the county in accor-
dance with subsecUons (e)(1) and (e)(2) of this section.
( 1) A written trust shall be verified by examining the trust documents
and any other related documents.
(2) An oral trust shall be verified by written affidavit and by any other
related documents. Affidavits shall be dated and signed under penalty of
perjury, and shall specify the terms of the oral agreement. Real property
cannot be held in an oral trust. Oral trusts which are held in financial insti-
tufions are subject to Section 50402.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.7, 14006 and 14015(a), Welfare and Institutions
Code; and Sections 1396a(r)(2)(A) and ]396p(c), (d) and (e), Title 42. United
States Code.
HtSTORY
1 . Repealer and new section filed 4-6-94; operative 5-6-94 (Register 94, No. 1 4).
For prior history, see Register 87, No. 30.
2. Repealer and new section filed 1-28-98; operative 1-28-98 pursuant to Gov-
ernment Code section 1 1343.4(d) (Register 98, No. 5).
§ 50489.1 . Medicaid Qualifying Trusts.
(a) Pursuant to Title 42, U.S.C, Secdon 1 396a(k) as it existed prior to
repeal, a Medicaid Qualifying Trust (MQT):
(1) Is one which was established prior to August 11, 1993, other than
by will, by an individual or the individual's spouse, or by the individual's
guardian, conservator, or legal representative who is acting on the indi-
vidual's behalf; and which
(2) Provides that the individual or the spouse may receive all or part
of the income or principal of the trust that is dispersed directly or to anoth-
er person or enfity on behalf of that individual; and which
(3) Gives the trustee(s) discretion in distributing funds to the individu-
al, to the spouse, or to another person or enfity on behalf of that individu-
al; and
(4) Is not described in Secfion 50489.9, and
(5) May be revocable or irrevocable, and
(6) May be established to enable the individual or the spouse to qualify
for Medi-Cal.
(b) For purposes of this section, "individual" means a person or spouse
who establishes an MQT and who is a beneficiary of the MQT.
(c) Property in an MQT is available as specified below:
(1) If the MQT is revocable, it shall be available.
(2) If the MQT is irrevocable then:
(A) Any amount distributed from the principal of the MQT to the indi-
vidual, to the spouse, or to another person or entity on behalf of that indi-
vidual or spouse shall be available property.
(B) Any amount distributed from the income of the MQT to the indi-
vidual, to the spouse, or to another person or entity on behalf of that indi-
vidual or spouse shall be considered income and shall be subject to Ar-
ficle 1 of this chapter.
(C) The maximum amount that the trustee(s) could distribute to the in-
dividual, to the spouse, or to another person or enfity on behalf of that in-
dividual or spouse from trust principal shall be considered available
property. The maximum amount is the amount the trustee(s) may distrib-
ute if the trustee(s) were to exercise full discrefion under l:he terms of the
MQT.
Page 362
Register 98, No. 5; 1-30-98
Title 22
Health Care Services
§ 50489.5
•
(D) The maximum amount that the taistee(s) may distribute to the in-
dividual, to the spouse, or to another person or entity on behalf of" that in-
dividual or spouse from taist income if the trustee(s) were to exercise full
discretion under the terms of the MQT is available income and is subject
to Article 10 of this chapter.
(E) Any amount of trust principal for which the trustee(s) has no dis-
cretion to release to the individual, to the spouse, or to another person or
entity on behalf of that individual or spouse shall be considered trans-
ferred property. The date of the transfer shall be the date the trust was es-
tablished, the date the trust receives the property, or the date disburse-
ment is foreclosed, whichever is the most recent.
(F) Any amount of trust income for which the trustee(s) has no discre-
tion to release to the individual, to the spouse, or to another person or enti-
ty on behalf of that individual or spouse shall be considered transferred
assets. The date of the transfer shall be the date trust disbursement is fore-
closed, or the date the trust recei ves income, whichever is the most recent.
Transfers of income occurring prior to August 11,1 993, shall not be con-
sidered.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.7, 14006 and 1401 5(a), Welfare and Institutions
Code; and Sections 1 396a(r)(2)( A) and 1396p(c), (d) and (e). Title 42, United
States Code.
History
1. New section filed 1-28-98; operative 1-28-98 pursuant to Government Code
section 11343.4(d) (Register 98, No. 5).
§ 50489.5. OBRA 93 Trusts Established On or After August
11,1993.
(a) An OBRA 93 trust:
(1) Is established, in part or in whole, with assets of an individual or
individual's spouse, on or after August 1 1 , 1993, other than by will; and
(2) Is not described in Section 50489.9, and
(3) Shall be treated in accordance with the remainder of this section.
(b) The provisions of this section shall apply to OBRA 93 trusts with-
out regard to:
(1) the purposes for which the trust is established,
(2) whether the trustee(s) has, or exercises, any discretion under the
terms of the trust,
(3) restrictions on when, or whether, distributions may be made from
the trust, or
(4) restrictions on the use of trust assets or distributions.
(c) The provisions of this section shall apply to any OBRA 93 trust if
it was established by any of the following:
(1) the individual, or
(2) the individual's spouse, or
(3) any other person or entity, including a court or administrative body,
with legal authority to act in place of, or on behalf of, the individual or
the individual' s spouse, regardless of whether that person or entity claims
to be acting in such a capacity at the time of the action, or
(4) any other person or entity, including any court or administrative
body, acting at the direction, or upon the request of, the individual or the
individual's spouse.
(d) In the case of an OBRA 93 trust which includes the assets of some-
one other than the individual or the individual's spouse, the provisions
of this section shall apply only to that portion of the trust containing the
assets of the individual or the individual's spouse.
(e) In the case of a revocable OBRA 93 trust:
(1) trust income and principal shall be considered property available
to the individual who has the right, power, and authority to revoke the
trust and to use the proceeds, and
(2) payments from the trust to, or for the benefit of, the individual or
spouse shall be considered income of that individual or spouse in accor-
dance with Article 10 of this chapter, and
(3) if payments are made to any person or entity, other than the individ-
ual or spouse, for any purpose other than for the benefit of the individual
or spouse, those payments shall be considered transferred assets as of the
date of payment.
(f) In the case of an irrevocable OBRA 93 taist:
(1) if payment(s) can be made from the trust to, or for the benefit of,
the individual or spouse at any time or under any circumstances, the por-
tion of the trust income or principal from which payment(s) to the indi-
vidual or spouse could be made shall be considered property available to
that individual or spouse,
(2) if payment(s) from the trust income or principal is made to, or for
the benefit of, the individual or spouse, the payment(s) shall be consid-
ered income of that individual or spouse, in accordance with Article 10
of this chapter,
(3) if payment(s) is made from the trust income or principal for any
other purpose, the payment(s) shall be considered a transfer of assets by
the individual or spouse as of the date of payment, and
(4) if any portion of the trust income or principal from which payment
cannot be made to, or for the benefit of, the individual or spouse, then that
portion shall be considered a transferred asset. The value of the assets
transferred shall include the amount of assets used to establish the trust
and any assets added to that portion. Payments which have been made
from that portion of the trust shall not be deducted from the value of the
assets transferred. The date of transfer shall be the date the trust was es-
tablished, the date the trust receives the asset or the date disbursement is
foreclosed, whichever is most recent.
(g) In the case of an annuity:
(1) Payments shall be considered income in accordance with Article
10 of this chapter, and
(2) Section 50402 shall apply only to the extent that it is not inconsis-
tent with subsections (g)(2)(A)-(g)(2)(D) of this section.
(A) The undistributed balance of the annuity shall be considered un-
available if the annuity contract is annuitized upon the life expectancy of
the individual or spouse or for a shorter period of time.
(B) The life expectancy of the annuitant shall be determined in accor-
dance with life expectancy tables specified by the Secretary of the De-
partment of Health and Human Services, contained in Section 3258.9
(Revision 64), Part 3 ofthe Health Care Financing Administration's State
Medicaid Manual and titled "Life Expectancy Table — Males and Life
Expectancy Table — Females".
(C) Any payment scheduled to occur beyond the life expectancy ofthe
individual or spouse as determined in accordance with subsection
(g)(2)(B) of this section shall be considered a transfer of assets.
(D) Any payment made to, or set aside for, another individual (other
than for the sole benefit of the spouse), shall be considered a transfer of
assets.
(h) The county must consider whether undue hardship exists before
eligibility may be denied under this section. Eligibility shall not be de-
nied based upon the provisions of this section if undue hardship is found
to exist. The provisions of this section shall be waived if the application
of these provisions would work an undue hardship. If undue hardship, in
accordance with the provisions of this subsection, is considered and
found not to apply, the county shall state that on the notice of action. For
purposes of this section, undue hardship exists when all ofthe conditions
in subsections (h)(1) through (h)(4) of this section exist or when the con-
ditions in subsections (h)(5) or (h)(6) of this section exists. The county
shall notify the individual that undue hardship is being considered prior
to denying eligibility to any individual under this section.
(1) The trust assets cannot, under any circumstances, be used to pro-
vide for the health care or medical needs of the Medi-Cal applicant or
Medi-Cal beneficiary, and
(2) Health care cannot be obtained from, and medical needs cannot be
met by, any source other than Medi-Cal without depriving the individual
of food, clothing or shelter or other necessities of life, and
(3) The individual's parents (if the individual is under 21) or the indi-
vidual's spouse, cannot provide for the health care and medical needs or
health care coverage of the individual without depriving themselves of
food, clothing or shelter or other necessities of life, and
Page 362.1
Register 98, No. 5; 1-30-98
§ 50489.9
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
(4) The courts have denied a good faith petition to release the trust as-
sets to pay for the required medical care.
(A) A petition to release the trust assets shall not be considered a vahd
good faith petition if the petition contains language which suggests or re-
quests that the courts do anything other than release the trust assets need-
ed to pay for the required medical care.
(B) The counties shall verify that the criteria contained in subsections
(h)(4) and (h)(4)(A) of this section, concerning a valid good faith petition
and court order exist by examining the petition and the court order.
(C) Subsection (h)(4) of this section does not apply to an annuity.
(5) No person shall be made ineligible to the extent the trust contains
otherwise exempt income or property.
(6) No person shall be made ineligible due to the application of subsec-
tion (g) of this section, concerning an annuity purchased prior to March
1, 1996 when the annuity cannot be annuitized to comply with the provi-
sions of subsection (g) of this section. Any annuity purchased prior to
March 1 , 1996 which cannot be annuitized to comply with the provisions
of subsection (g) of this section, shall continue to be considered in accor-
dance with Section 50402.
NOTE: Authority cited: Sections 10725 and 14124.3, Welfare and Institutions
Code. Reference: Sections 14005.7, 14006 and 14015(a), Welfare and institutions
Code; and Sections 1396a(r)(2)(A) and 1396p(c), (d) and (e), Title 42, United
Stales Code.
History
1. New section filed 1-28-98; operative 1-28-98 pursuant to Government Code
section 1 1343.4(d) (Register 98, No. 5).
§ 50489.9. Trusts Other than Those Described in 50489.1
or 50489.5.
(a) Trusts described in subsections (a)(1) through (a)(4) of this section,
shall be considered available in accordance with subsection (b) of this
section:
(1) Trusts that are not described in Section 50489.1 or Section
50489.5.
(2) Any trust established prior to April 7, 1 986, which benefits no one
other than a mentally retarded person who resides in an intermediate care
facility for the mentally retarded.
(3) A trust established on or after August 1 1 , 1993, which meets all of
the following conditions:
(A) A trust, or portion of a trust, that contains the assets of an individual
or spouse who was both disabled as verified in accordance with Section
50167(a)(l ) and under the age of 65 when the trust was estabUshed and
who is currently disabled whether or not he/she is age 65 or over, and
(B) A trust that is established for the benefit of the disabled individual
or disabled spouse in subsection (a)(1)(A) of this section by a parent,
grandparent, legal guardian of the individual, or a court, and where
(C) The State receives all remaining funds in the trust, or respective
portion of the trust, upon the death of the individual or spouse or upon
termination of the trust up to an amount equal to the total medical assis-
tance paid on behalf of that individual by the Medi-Cal program. A trust,
or respective portion of the trust, will stiU be considered for the benefit
of the individual or spouse if the trust permits funds to be used for other
purposes when the trust's terms permit such use only after payment of the
State's interest pursuant to this subsection.
(4) A trust established on or after August 1 1, 1993, which meets all the
conditions listed in subsections (a)(4)(A) through (a)(4)(F) of this sec-
tion:
(A) the trust contains the assets of the individual or spouse who is dis-
abled as verified in accordance with Section 50167(a)(1), and
(B) the trust is established and managed by a nonprofit association,
and
(C) a separate account is maintained for each trust beneficiary, but for
purposes of investment and management of funds, the trust pools these
accounts, and
(D) the accounts in the trust are established, except for purposes of
subsection (a)(4)(E) of this section, solely for the benefit of the disabled
individual or disabled spouse, as defined in subsection (a)(4)(F) of this
section, by the disabled individual or disabled spouse, his or her parents,
his or her grandparents, or the legal guardian of that individual, or by a
court, and
(E) the State receives, upon the death of the disabled individual or dis-
abled spouse, all funds remaining in the individual's account, up to an
amount equal to the total amount of medical assistance paid on behalf of
that individual by the Medi-Cal program. The State shall receive this
amount only to the extent that funds remain in that individual's account
and are not retained by the trust to cover management and investment
fees associated with that account.
(F) In determining whether an account may be considered solely for
the benefit of the disabled individual or disabled spouse, both subsections
(a)(4)(F)(l) and (a)(4)(F)(2) of this section shall apply.
(1) Except in accordance with subsection (a)(4)(E) of this section, the
account funds must benefit no one other than the disabled individual or
disabled spouse for whose benefit the account was established before the
State's interest has been satisfied pursuant to subsection (a)(4)(E) of this
section.
(2) If the trust permits funds to be used for any purpose other than for
the sole benefit of the disabled individual or disabled spouse for whose
benefit the trust or account was established, before the State's interest has
been satisfied pursuant to subsection (a)(4)(E) of this section, the account
will not be considered solely for the benefit of that individual or spouse.
Such accounts shall be treated pursuant to Section 50489.5. An account
will still be considered for the sole benefit of the individual or spouse if
the trust permits funds to be used for other purposes v/hen the trust's
terms permit such use only after payment of the State's interest pursuant
to subsection (a)(4)(E) of this section.
(b) Trusts described in subsections (a)(1) of this section through (a)(4)
of this section, shall be considered available as specified in subsections
(b)(1) and (b)(2) of this section.
(1) If the trust is revocable, trust income and principal shall be consid-
ered available to the person who has the right, power, and authority to re-
voke the trust and to use the proceeds.
(A) Trust income is income, and is subject to Article 10 of this chapter.
If trust income is not distributed in the month of receipt, it is available
property.
(B) Trust principal is available property.
(2) If the trust is irrevocable, the trust assets are not available until dis-
tributed.
(c) Any augmentations or additions made to a trust described in sub-
section (a)(3) of this section or subsection (a)(4) of this section after the
disabled individual or disabled spouse for whose benefit the trust was es-
tablished reaches the age of 65 shall be considered a transfer of assets for
less than adequate consideration; earlier augmentations or additions shall
not be considered transferred for less than adequate consideration.
(d) In the case of a trust described in subsection (a)(3) of this section
or (a)(4) of this section, to ensure that the Department recovers the costs
of medical care it provided, the Department's Third Party Liability
Branch shall be notified
(1) by the county, whenever the county becomes aware of a Medi-Cal
applicant or Medi-Cal beneficiary who is a trust beneficiary, and
(2) by the trustee, upon death of the trust beneficiary, termination of
the trust, or change of trustee.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.7, 14006 and 14015(a), Welfareandlnstitutions
Code; and Sections 1396a(r)(2)(A) and 1396p(c), (d) and (e). Title 42, United
States Code.
History
1. New section filed 1-28-98; operative 1-28-98 pursuant to Government Code
section 11343.4(d) (Register 98, No. 5).
Article 10. Income
§50501. Income — General.
(a) Income includes benefits in cash or in kind from:
(1) Labor.
(2) Services provided.
(3) Business activities.
(4) Returns from real or personal property.
Page 362.2
Register98, No. 5;l-30-
Title 22
Health Care Services
§ 50507
•
•
(5) Contributions.
(6) Other similar sources.
(b) Income from sources listed in (a) shall be considered as income
only if it is currently available in accordance with Sections 50513
through 50517.
(c) Income from sources listed in (a) shall be divided into three types:
(1) Gross earned income as described in Section 50503.
(2) Gross unearned income as described in Section 50507.
(3) Income in kind as described in Section 50509.
NOTE; Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4, 14005.7, 14005.9 and 14005.12, Welfare and
Institutions Code.
History
1. Editorial coirection adding Note filed 6-10-83 (Register 83, No. 24).
§ 50503. Gross Earned Income.
(a) Gross earned income includes:
(1) Wages, including amounts designated for meals provided by an
employer or business enterprise, salaries, bonuses and commissions
from an employer or business enterprise.
(2) Net profits from self-employment as determined in accordance
with Section 50505.
(3) Earnings under Title 1 of the Elementary and Secondary Education
Act.
(4) Payments under the Job Training Partnership Act (JTPA). Pay-
ments which are identified by the local JTPA office as an incentive pay-
ment or training allowance shall be considered as gross unearned income.
(5) Payments under the Economic Opportunity Act.
(6) Training incentive payments and work allowances under ongoing
manpower programs other than WIN or JTPA.
(7) Income received for having provided IHSS services.
(8) Net income from real or personal property as determined in accor-
dance with Section 50508 which is the result of continuous and apprecia-
ble effort on the part of the applicant or beneficiary. This includes income
from:
(A) Room and board.
(B) The rental of rooms which requires daily effort on the part of the
beneficiary.
(C) A business enterprise.
(D) The sale of produce, livestock, poultry, dairy products and other
similar items.
(9) Earnings from public service employment.
(10) Actual Earned Income Tax Credit (EITC) payment received for
taxable year 1980 and thereafter whether received as a tax refund or re-
ceived as an advance payment.
(11) Tips actually received for the performance of work activities, not-
withstanding the amount calculated by the employer for tax withholding
purposes.
(12) For purposes of applying Sections 50543, 50553.1 , 50553.3, and
50553.5 of Title 22 of the California Code of Regulations to AFDC-MN
or MI persons. Temporary Workers Compensation payments which are
(i) employer funded, (ii) made to an individual who remains employed
during recuperation from a temporary illness or injury pending his/her re-
turn to the job, and (iii) are specifically characterized under State law as
temporary wage replacements.
(13) For purposes of applying Sections 50543, 50553.1 , 50553.3, and
50553.5 of Title 22 of the California Code of Regulations to AFDC-MN
or Ml persons, State Disability Insurance payments.
Note. Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; Sawyer v. Anderson, Belshe, et al., U.S. District Court, EDCA, No. CIV
S-94-0228 GEB JFM; and Tinoco v. Belshe, U.S. District Court, NDCA, No. C94
0947 WHO. Reference: Sections 14005.4, 14005.7 and 14005.8, Welfare and In-
stitutions Code.
History
1 . Amendment filed 3-7-80; effective thirtieth day thereafter (Register 80, No. 9).
2. New subsections (a)(IO) and (b) filed 4-15-85 as an emergency; effective upon
filing (Register 85, No. 16). A Certificate of Compliance must be transmitted
to OAL within 120 days or emergency language will be repealed on 8-13-85.
3. Certificate of Compliance as to 4-1 5-85 order transmitted to OAL 8-13-85 and
filed 9-18-85 (Register 85, No. 38).
4. Amendment filed 6-3-87; operative 7-3-87 (Register 87, No. 24).
5. New subsections (a)(l2) and (a)(I3) and amendment of NOTE filed 3-1 1-97;
operative 4-10-97 (Register 97, No.l I).
§ 50505. Net Profit from Self-Employment.
(a) The net profit from self-employment shall be an estimation of the
annual net income for the current year based on the federal tax return filed
for the previous year as limited by (c).
(b) If there is no tax return for the previous year or there is evidence
that using the tax return would give an inaccurate estimation of income,
the county department shall use current business records. In this circum-
stance, net profit shall be determined in accordance with (d) and (e).
(c) The following expenses, when used to determine annual net in-
come on the federal tax return, shall not be deducted:
(1) Entertainment costs.
(2) Depreciation.
(3) Purchase of capital equipment expenditures.
(4) Payments on the principal of loans for capital assets or durable
goods.
(d) Net profit of a self-employed person shall be determined by sub-
tracting from the gross business income, expenses which are directly re-
lated to the production of goods or services, and without which the goods
or services could not be produced. Such expenses include, but are not
hmited to:
(1 ) Transportation costs to call upon customers or deliver goods.
(2) Payments of the interest of loans for capital assets or durable goods.
(3) Payments for rental of space or equipment.
(4) Wages and other benefits paid to employees.
(5) Material and supply costs.
(6) Maintenance and repair costs.
(e) Personal expenses such as income tax payments, lunches and trans-
portation to and from work are not classified as business expenses and
shall not be deducted.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Secnons 14005.4, 14005.7, 14005.9 and 14005.12, Welfare and
Insfitutions Code.
History
1. Editorial correction adding Note filed 6-10-83 (Register 83, No. 24).
2. Amendment filed 4-17-89; operafive 5-17-89 (Register 89, No. 48).
§ 50507. Gross Unearned Income.
(a) Gross unearned income includes:
(1) Old age, survivors and disability insurance payments from the So-
cial Security Administration (OASDI).
(2) Annuities, which are sums paid yearly or at other specific intervals
in return for payment of a fixed sum by the annuitant.
(3) Pensions.
(4) Retirement payments.
(5) Disability payments except for the State Disability Insurance bene-
fits considered to be earned income under Section 50503(a)(13) of this
Title.
(6) Veterans payments which include:
(A) Pensions based on need.
(B) Compensation payments.
(C) Educational assistance.
(7) Workers' Compensation payments, except for any amount deter-
mined to be unavailable in accordance with Section 50515, and except
for Temporary Workers Compensation payments considered to be
earned income under Section 50503(a)(12) of this Title.
(8) Railroad Retirement and any other payments made by the Railroad
Retirement Board.
(9) Unemployment Insurance Benefits.
(10) Proceeds from a life insurance policy which are in excess of the
lesser of:
(A) $1,500.
(B) The amount expended on the insured person's last illness and buri-
al expenses.
Page 362.3
Register 98, No. 5; 1 -30-98
§ 50508
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
(11) Other insurance payments.
(12) Loans which do not require repayment.
(J 3) Gifts.
(14) Non-exempt child/spousal support, whether provided voluntari-
ly or by court order.
(15) Inheritances which are in the form of cash, securities or other liq-
uid assets.
(16) Contributions from any source.
(17) Prizes and awards.
(18) Net income from the rental of real or personal property which is
not considered gross earned income in accordance with Section
50503(a)(8).
(19) Dividends.
(20) Interest payments from any source, including trust, trust deeds
and contracts of sale.
(21) Royalties, including but not limited to payments to a holder of a
patent or copyright, for the use of the invention, or to the owner of a mine,
oil well or similar holdings, for the extraction of the product or other use.
(22) Income of a PA or Other PA recipient which is not used to deter-
mine the recipient's eligibility.
(23) Incentive payments or training allowances under JTPA.
(24) Any other income which is available to meet current needs in ac-
cordance with Section 50513.
(25) Any of the items specified in (10) through (24) if received in a
lump sum payment.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; Sawyer v. Anderson, Belshe, et a!.. U.S. District Court, EDCA, No. CIV
S-94-0228 GEB JFM; and Tinoco v. Belshe, U.S. District Court, NDCA, No. C94
0947 WHO. Reference: Sections 14005.4, 14005.7 and 14005.8, Welfare and In-
stitutions Code.. Reference: Sections 14005.4, 14005.7, 14005.8 and 14006, Wel-
fare and Institutions Code.
History
1 . Amendment of subsections (a)(1), (a)(l 2) and (a)(22) filed 9-1 7-79 as an emer-
gency; effective upon filing (Register 9, No. 38). A Certificate of Compliance
must be filed within 120 days or emergency language will be repealed on
1-15-80.
2. Certificate of Compliance transmitted to OAL 1-8-80 and filed 1-16-80 (Reg-
ister 80, No. 3).
3. Amendment of subsection (a)(14) and new subsection (b) filed 4—15-85 as an
emergency; effective upon filing (Register 85, No. 16). A Certificate of Com-
pliance must be transmitted to OAL within 120 days or emergency language
will be repealed on 8-13-85.
4. Certificate of Compliance including amendment of subsection (a) transmitted
to OAL 8-13-85 and filed 9-18-85 (Register 85, No. 38).
5. Amendment filed 6-3-87; operative 7-3-87 (Register 87, No. 24).
6. Amendment of subsection (a)(6) filed 2-16-88 as an emergency; operative
2-1 6-88 (Register 88, No. 10). A Certificate of Compliance must be transmitted
to OAL within 120 days or emergency language will be repealed on 6-15-88.
7. Emergency language filed 2-16-88 repealed by operation of Government Code
Section 1 1 346. 1 (Register 88, No. 27).
8. Amendment of subsecdon (a)(6) refiled 6-22-88 as an emergency; operative
6-22-88 (Register 88, No. 27). A Certificate of Compliance must be transmitted
to OAL within 1 20 days or emergency language will be repealed on 10-20-88.
9. Certificate of Compliance transmitted to OAL 6-20-88 and filed 7-15-88
(Register88, No. 31).
10. Amendment of subsections (a)(5) and (a)(7) and amendment of NOTE filed
3-11-97; operative 4-10-97 (Register 97, No.ll).
§ 50508. Net Income from Property.
(a) Net income from property shall be considered in determining share
of cost and shall be computed as follows:
( 1 ) If the income is from the rental of real property, subtract the follow-
ing expenses, as limited by (b), from the gross income:
(A) Taxes and assessments.
(B) Interest on encumbrance payments. The principal portion of the
payments shall not be deducted.
(C) Insurance.
(D) Utilities.
(E) Upkeep and repairs. The amount of this item shall be the greater
of the following:
1. The actual amount expended for upkeep and repairs during the
month.
2. Fifteen percent of the gross monthly rental plus $4.17 per month.
(2) In determining whether utilization requirements are met in accor-
dance with Section 5041 6 (a) (1 ) only the amount specified in (a) ( 1 ) (E)
1. shall be deducted rather than the amount specified in (a) (1 ) (E) 2.
(3) If the income is from the rental of rooms, or the provision of board
and room or board and care, which does not require a business license,
the net income shall be 10 percent of the gross amount received.
(4) If the income is from the provision of board and room or board and
care which requires a business license, or from self-employment, the net
income is the net profit from self-employment as determined in accor-
dance with Section 50505.
(5) If the income is from a deed of trust or a mortgage, the net income
is the amount specified in Section 50441 (c).
(6) If the income is from property in which the person holds a life es-
tate, the net income is the ainount actually received.
(7) If the income is from personal property, the net income is the
amount actually received.
(b) If the income is from the rental of unit(s) of a multiple unit dwelling
or other dwellings on property that is exempt as the principal residence
and the applicant or beneficiary is living in a portion of the property, the
expenses specified in (a) which are common to the property as a whole
shall be prorated as follows:
(1) Determine the number of rooms in the building. If there is more
than one building, determine the number of rooms in all of the buildings
together. For the purpose of this section, rooms include any room other
than the following:
(A) Bathroom.
(B) Hallway.
(C) Closet.
(D) Unfinished basement, loft or attic.
(2) Determine the number of rooms which are producing the rental in-
come.
(3) Based upon the number of rooms, determine the percentage of the
property which is producing the rental income.
(4) Apply the percentage determined in accordance with (3) to the ex-
penses specified in (a) which are common to the property as a whole. This
is the amount which shall be subtracted from the gross income.
NOTE: Authority cited: Sections 10725, 14006.1 and 14124.5, VMfare and Insti-
tutions Code. Reference: Sections 14005.4, 14005.7 and 14006, Welfare and Insti-
tutions Code.
History
1 . Amendment of subsection (a)(5) filed 1 2-15-77; effective thirtieth day thereaf-
ter (Register 77, No. 51 ).
2. Editorial correction adding Note filed 6-10-83 (Register 83, No. 24).
3. Amendment of subsecfion (a)(1) and new subsection (b) filed 12-2-85 as an
emergency; effective upon filing (Register 85, No. 50). A Certificate of Com-
pliance must be transmitted to OAL within 120 days or emergency language
will be repealed on 4-1-86.
4. Certificate of Compliance transmitted to OAL 3-31-86 and filed 4-30-86
(Register 86, No. 18).
§ 50509. Income in Kind.
(a) Income in kind is any support or maintenance received in kind from
a person other than a responsible relative for:
(1) Housing.
(2) Utilities.
(3) Food.
(4) Clothing.
(b) Income in kind shall be considered as income only if the entire item
of need is provided.
(c) The value of free board and lodging received during a temporary
absence from the home shall be considered as follows:
(1) If the absence is for one month or less, the income in kind value
shall not be considered income.
[The next page is 363.]
Page 362.4
Register 98, No. 5; 1-30-98
Title 22
Health Care Services
§ 50512
•
(2) If the absence is for more than one month, the income in kind value
shall be considered income to the extent that it exceeds the actual costs
of maintaining the home to which the beneficiary will return.
(d) Income in kind which is received as earned income shall be subject
to earned income exemptions and deductions.
(e) Income in kind which is received as unearned income shall be sub-
ject to unearned income exemptions and deductions.
(0 Income in kind from a parent shall not be considered in determining
the eligibility of a child when any of the following conditions exists:
(1) The child's application is being processed for minor consent ser-
vices in accordance with Section 50147.1(a)(3)(D).
(2) The child is an unmarried minor parent and the share of cost is be-
ing determined for the MFBU that includes the child's children.
(3) The child is an unborn, except that if the mother is receiving in-
come in kind, there is income in kind to the unborn.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4 and 14005.7, Welfaie and Institutions Code.
History
1 . New subsection (0 filed 1-8-81 : effective thirtieth day thereafter (Register 81,
No. 2).
§ 5051 1 . Value of Income In Kind.
(a) Tlie value of the income in kind for the items specified in Section
50509 (a) shall be the lesser of the following:
(1) The actual cost or net market value of the item, or
(2) The income in kind amounts effective July 1, 1981 for housing, uti-
lities (including telephone), food and clothing specified in (d) as adjusted
for any increases or decreases in the cost of hving specified in (b).
(b) Individual income in kind amounts shall be adjusted by the same
percentage increase or decrease that is applied to the AFDC Maximum
Aid Payment levels pursuant to Section 11453 Welfare and Institutions
Code. Such adjustments shall be effective at the same time as adjust-
ments to the AFDC payment levels become effective as specified in Sec-
tion 11453, Welfare and Institutions Code.
(c) If one of the items listed in 50509(a) is shared with persons who are
not included in the MFBU and who are not responsible for members of
the MFBU, the income in kind value to the members of the MFBU shall
be the lesser of:
(1) Their share of the net market value or actual cost of the item.
(2) The value determined in accordance with (a) (2).
(d) The income in kind amounts effective July 1, 1981 are as follows:
(1) Housing.
(A) One person MFBU $1 1 1 per month.
(B) Two person MFBU $150 per month.
(C) Three person MFBU $163 per month.
(1) Housing.
(A) One person MFBU $111 per month.
(B) Two person MFBU $150 per month.
(C) Three person MFBU $163 per month.
(D) Four person or larger MFBU $173 per month.
(2) Utilities, including telephone.
(A) One person MFBU $25 per month.
(B) Two person MFBU $26 per month.
(C) Three person MFBU $28 per month.
(D) Four person or larger MFBU $29 per month.
(3) Food.
(A) One person MFBU $62 per month.
(B) Two person MFBU $133 per month.
(C) Three person MFBU $169 per month.
(D) Four person MFBU $209 per month.
(E) Five person MFBU $252 per month.
(F) Six person MFBU $293 per month.
(G) Seven person MFBU $327 per month.
(H) Eight person MFBU $358 per month.
(I) Nine person MFBU $391 per month.
(J) Ten person or larger MFBU $424 per month.
(4) Clothing.
(A) One person MFBU $20 per month.
(B) Two person MFBU $37 per month.
(C) Three person MFBU $56 per month.
(D) Four person MFBU $74 per month.
(E) Five person MFBU 92 per month.
(F) Six person MFBU $1 10 per month.
(G) Seven person MFBU $129 per month.
(H) Eight person MFBU $144 per month.
(I) Nine person MFBU $165 per month.
(J) Ten person or larger MFBU $1 81 per month.
NOTE; Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; Section 32, SB 633, Statutes of 1981, Chapter 69. Reference: Sections
14005.4 and 14005.7, Welfare and Institutions Code.
History
1. Amendment filed 7-1-77 as an emergency; effective upon filing (Register 77,
No. 27).
2. Certificate of Compliance filed 10-27-77 (Register 77, No. 44).
3. Amendment filed 9-25-79 as an emergency; effective upon filing (Register 79,
No. 39). A Certificate of Compliance must be filed within 120 days or emergen-
cy language will be repealed on 1-23-80.
4. Certificate of Compliance filed 1-16-80 (Register 80, No. 3).
5. Amendment of subsections (a) and (c) filed 9-30-80 as an emergency; effective
upon filing (Register 80, No. 40). A Certificate of Compliance must be trans-
mitted to OAL within 120 days or emergency language will be repealed
1-30-81.
6. Amendment of subsections (a) and (c) filed 12-3-80; effective thirtieth day
thereafter (Register 80, No. 49).
7. Certificate of Compliance as to 9-30-80 order filed 1-27-81 (Register 81 , No.
5).
8. Amendment of subsections (a) and (c) filed lQ-2-81 as an emergency; effective
upon filing (Register 81, No. 40).
9 . Certificate of Compli ance as to 1 0-2-8 1 order transmitted to OAL 1 - 1 5-82 and
filed 2-1-82 (Register 82, No. 6).
10. Amendment filed 1-13-86; effective thirtieth day thereafter (Register 86, No.
3).
§50512. Ownership of Income.
(a) Except as specified in (b), income is considered to belong to the
person who:
(1) Is named on a negotiable instrument.
(2) Is given cash.
(3) Receives the income in kind.
(b) In the case of a married couple it shall be presumed that each spouse
has a one-half community property ownership interest in the total
monthly gross earned and unearned income of both spouses providing all
of the following conditions exist:
(1) One spouse is in LTC and the other spouse is noninstitutionalized.
(2) There is no break in marital ties.
(3) The LTC spouse receives an amount of income which is greater
than the amount of income received by the noninstitutionalized spouse.
(c) The community property ownership presumption in (b) shall be re-
buttable by either spouse who provides evidence that all or a portion of
the total income is owned separately by one spouse.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; and Section 5, Chapter 122 1 , Statutes of 1985. Reference: Sections 14005.4,
14005.7 and 14005.16, Wellareand Institutions Code; and Sections 687, 51 05 and
51 10, Civil Code.
History
1. Renumbering and amendment of former Section 50513(d) to Section 50512
filed 12-2-85 as an emergency; effective upon filing (Register 85, No. 50). A
Certificate of Compliance must be transmitted to OAL within 120 days or emer-
gency language will be repealed on 4-1-86. For prior history, see Register 77,
No. 51.
2. Renumbering and amendment of former Section 50513(d) to Section 50512 re-
filed 3-28-86 as an emergency; effective upon filing (Register 86, No. 13). A
Certificate of Compliance must be transmitted to OAL within 120 days or emer-
gency language will be repealed on 7-28-86.
Page 363
(4-1-90)
§ 50513
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
3. Certificate of Compliance includins amendment of subsection (b) as to 3-28-86
ordered filed 6-6-86 (Register 86rNo. 23).
EXPLANATORY NOTE:
1 . Approval by OAL of the Certificate of Compliance for the amendment of Sec-
tion 50512, filed 6-6-86, was made in the absence of a final determination by
the Secretary of the United States Department of Health and Human Services
pursuant to Section 1 1 16 of the federal Social Security Act that a conflict exists
between Section 50512 or Chapter 1221 of the California Statutes of 1985 and
any federal statute or regulation.
§50513. Availability of Income.
(a) Only income which is actually available to meet the needs of a per-
son or family shall be considered in determining that person's or family's
share of cost.
(b) Income shall be considered available in the month it is received un-
less it is:
(1) To be apportioned over time in accordance with Section 50517.
(2) Unavailable in accordance with Section 50515.
(c) Income is considered to be received on the day it becomes available
for use by the person.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; and Section 5, Chapter 1221, Statutes of 1985. Reference: Sections 14005.4,
14005.7 and 14005.16, Welfare and Institutions Code: and Sections 687, 5105 and
5110, Civil Code.
History
1. Amendment of subsection (d) filed 12-1 5-77; effective thirtieth day thereafter
(Register77, No. 51).
2. Renumbering and amendment of Section 50513(d) to Section 50512 filed
12-2-85 as an emergency; effective upon filing (Register 85, No. 50). A Certifi-
cate of Compliance must be transmitted to OAL within 1 20 days or emergency
language will be repealed on 4-1-86.
3. Renumbering and amendment of Secfion 50513(d) to Section 50512 refiled
3-28-86 as an emergency ; effective upon filing (Register 86, No. 1 3). A Certifi-
cate of Compliance must be transmitted to OAL within 1 20 days or emergency
language will be repealed on 7-28-86.
§ 50515. Unavailable Income.
(a) Income which is not available to meet current needs of a person or
family shall not be considered in determining that person's or family's
share of cost. Unavailable income includes, but is not limited to, the fol-
lowing:
(1 ) That portion of Worker' s Compensation and other public or private
insurance settlements which is either of the following:
(A) Designated for medical, legal or other such expenses.
(B) Not controlled by the applicant or beneficiary or person acting on
his behalf
(2) That portion of a contribution that is both of the following:
(A) From a person living in the household who has no legal responsi-
bility to support, such as an unrelated adult or an adult child.
(B) Used to meet the actual costs of the contributor' s share of the hous-
ing, utilities, food and other household costs. If actual costs are unavail-
able, the amounts specified in Section 50511 shall be used. This shall be
the difference between the income-in-kind values for the family size
with the person included and excluded.
(3) That portion of the monthly income of a medically needy person
residing in a licensed board and care facility which is both of the follow-
ing:
(A) Paid to the facility for residential care and support,
(B) In excess of the appropriate maintenance need level as determined
in accordance with Section 50603.
(4) An advance or a reimbursement from an employer to cover ex-
penses necessary for job performance is unavailable to the extent that the
advance or reimbursement does not exceed the actual out-of-pocket
costs of the employee.
(b) When a person is in LTC and is in his/her own MFBU in accor-
dance with Section 50377, his/her spouse's share of the community prop-
erty owned income shall be considered unavailable to the LTC person.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4, 14005.7 and 14005.16, Welfare and Institu-
tions Code.
History
1. New subsection (a)(3) filed 11-17-83 as an emergency; effective upon filing
(Register 83, No. 49). A Certificate of Compliance must be transmitted to OAL
within 120 days or emergency language will be repealed on 3-1 7-84.
2. Certificate of Compliance as to 1 1-17-83 order transmitted to OAL 3-16-84
and filed 4-17-84 (Register 84, No. 16).
3. New subsection (b) filed 1 2-2-85 as an emergency; effective upon filing (Reg-
ister 85, No. 50). A Certificate of Compliance must be transmitted to OAL with-
in 120 days or emergency language will be repealed on 4-1-86.
4. New subsection (b) refiled 3-28-86 as an emergency; effective upon filing
(Register 86. No. 13). A Certificate of Compliance must be transmitted to OAL
within 120 days or emergency language will be repealed on 7-28-86.
5. Certificate of Compliance as to 3-28-86 order filed 6-6-86 (Register 86, No.
23).
EXPLANATORY NOTE:
1 . Approval by OAL of the Certificate of Compliance for the amendment of Sec-
tion 50515(b), filed 6-6-86, was made in the absence of a final determination
by the Secretary of the United States Department of Health and Human Services
pursuant to Section 1 1 16 of the federal Social Security Act that a conflict exists
between Section 50515(b) or Chapter 1221 of the California Statutes of 1985
and any federal statute or regulation.
6. New subsecfion (a)(4) filed 7-9-87; operaUve 8-8-87 (Register 87, No. 30).
§ 5051 7. Apportionment of Income over Time.
(a) Income shall be considered available in the month received, unless
it is apportioned over time in accordance with the following:
(1) Income earned and received in more than eight but less than twelve
months under an annual contract of employment shall be apportioned
equally over the period of the contract beginning with the first month of
the contract.
(2) Income received more frequently than monthly or semi-monthly
shall be converted to monthly income in accordance with (3) if both of
the following conditions are met:
(A) The beneficiary wishes to receive Medi-Cal for more than two
months.
(B) The beneficiary is to receive the income for a full month.
(3) Income shall be converted to monthly income by the following
methods:
(A) Multiply weekly income by 4.33 or 4 1/3.
(B) Multiply income received every two weeks by 2. 167 or 2 1/6.
(4) Income received less frequently than monthly shall be converted
to monthly income by the following methods.
(A) Divide quarterly income by three.
(B) Divide income received every two months by two.
(5) Income from self-employment, as determined in accordance with
Section 50505, shall be determined on an annual basis and apportioned
monthly.
(6) Loans which do not require repayment and are not exempt in accor-
dance with Section 50533, and which specify that they are to cover a cer-
tain period of time shall be apportioned over that period of time.
(7) Interest income from a deed of trust or contract of sale shall be de-
termined on an annual basis and apportioned monthly.
(8) Interest income which is received less frequently than monthly and
is not exempt as specified in Section 50542 shall be apportioned as fol-
lows:
(A) Determine the number of months of the period during which the
interest accrued.
(B) Divide the interest income by the number of months in the interest
period.
(C) Consider the amount determined in (B) as income in each of the
months of the next interest period.
NOTE: Authority cited: Sections 10725, 14005.9(c) and 14124.5, Welfare and In-
stitufions Code; Section 133.5, AB 251, Chapter 102, Statutes of 1981 . Reference:
Sections 14005.4, 14005.7, 14005.9, and 14006, Welfare and Institutions Code.
History
L Amendment of subsection (a) and repealer of subsection (b), filed 12-15-77;
effective thirtieth day thereafter (Register 77, No. 51).
2. Amendment of subsection (a)(6) filed 9-1 7-79 as an emergency; effective upon
filing (Register 79, No. 38). A Certificate of Compliance must be filed within
120 days or emergency language will be repealed on 1-15-80.
3. Certificate of Compliance transmitted to OAH 1-8-80 and filed 1-16-80 (Reg-
ister 80, No. 3).
Page 364
(4-1-90)
Title 22
Health Care Services
§ 50528
•
4. Amendment filed 11-30-81 as an emergency; effective upon filing (Regisier
81 , No. 49). A Certificate of Compliance must be transmitted to OAL within 1 20
days or emergency language will be repealed on 3-30-82.
5. Certificate of Compliance filed 3-30-82 (Register 82, No. 14).
6. Amendment of subsection (a) filed 10-1-82 as an emergency; effective upon
filing (Register 82, No. 40). A Certificate of Compliance must be transmitted
to OAL within 120 days or emergency language will be repealed on 1-29-83.
7. Certificate of Compliance transmitted to OAL 12-30-82 and filed 2-2-83
(Register 83, No. 6).
§ 5051 7.1 . Apportionment of Income Exemptions and
Deductions.
(a) Income exemptions and deductions shall be apportioned over time
using the procedures for apportioning income over time.
NOTE: Authority cited: Sections 10725 and 14124.5. Welfare and Institutions
Code. Reference: Sections 14005.4 and 14005.7, Welfare and Institutions Code.
History
1 . New section filed 1 2-1 5-77; effective thirtieth day thereafter (Register 77, No.
51).
2. Editorial con-ection adding NOTE filed 6-1 1-83 (Register 83, No. 24).
§ 50518. Fluctuating Income.
(a) Fluctuating income shall be determined by estimating the amount
to be received in the month unless the conditions of (b) are met. This esti-
mate shall be made considering all of the following:
(1) The income pattern over the last year.
(2) The actual income received in the last month.
(3) The beneficiary's statement of anticipated income.
(b) Actual income shall be used if it is known at the time the share of
cost determination is being made. In no instance shall the share of cost
determination be delayed solely to determine the actual income.
(c) The provisions of this section shall not apply to income from self-
employment which shall be determined in accordance with Section
50505 and apportioned in accordance with Section 50517(a)(5).
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4, 14005.7 and 14005.12, Welfai'e and Institu-
tions Code.
History
1. Editorial correcfion adding NOTE filed 6-10-83 (Register 83, No. 24).
2. New subsection (c) filed 7-9-87; operative 8-8-87 (Register 87, No. 30).
§ 50519. Income Exemptions and Deductions — General.
(a) Certain items of earned and unearned income shall be exempt from
consideration in determining a beneficiary's share of cost. Income which
remains after the apphcation of the exemptions specified in Sections
50523 through 50544 shall be nonexempt income.
(b) Certain amounts of income shall be deducted from nonexempt in-
come to determine the net income to be used in determining the share of
cost. Income which remains after the application of the deductions speci-
fied in Sections 50547 through 50555.2 shall be net nonexempt income.
(c) Exemptions and deductions do not apply uniformly to all MN and
MI categories nor to both earned and unearned income. Restrictions are
stated where applicable.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; and Section 57(c), Chapter 328, Statutes of 1982. Reference: Secfions
14005.4 and 14005.7, Welfare and Institutions Code.
History
1. Amendment of subsection (b) filed 8-18-82 as an emergency; effective upon
filing (Register 82, No. 34). A Certificate of Compliance must be transmitted
to OAL within 120daysoremergency language will be repealed on 12-16-82.
2. Certificate of Compliance transmitted to OAL 12-16-82 and filed 1-21-83
(Register 83, No. 4).
3. Amendment of NOTE filed 4-12-83 (Register 83, No. 16).
§ 50521 . Payments Exempt from Consideration as Income.
Income specified in Sections 50523 through 50544 shall be exempt.
These exemptions shall apply to all MN and MI persons, unless other-
wise specified.
§ 50523. Property Tax Refunds.
Refunds or rebates of taxes on real property shall be exempt.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institufions
Code. Reference: Sections 14005.4 and 14005.7, Welfare and Institutions Code.
History
1 . Editorial conecfion adding NOTE filed 6-10-83 (Register 83, No. 24).
§ 50523.5. California Franchise Tax Board Payments.
The payments which are exempt property pursuant to Section 50454.5
shall also be exempt income in the month of receipt.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 1 1008.4, Welfare and Institutions Code.
History
1. New section filed 4-17-89; operative 5-17-89 (Register 89, No. 48).
§ 50524. Child/Spousal Support Received by AFDC-MN
and Ml Family Members.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; and Section 14, Chapter 1447, Statutes of 1984. Reference: Sections
14005.4, 14005.7 and 14005.8, Welfare and Insfitufions Code.
History
1 . New section filed 4-15-85 as an emergency; effective upon filing (Register 85,
No. 16). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 8-13-85.
2. Certificate of Compliance transmitted to OAL 8-13-85 and filed 9-18-85
(Register 85, No. 38).
3. Renumbering and amendment of Section 50524 to Secfion 50554.5 filed
7-9-87; operative 8-8-87 (Register 87, No. 30).
§ 50525. Public Assistance and General Relief Grants.
(a) Public assistance cash grants shall be exempt.
(b) In addition to public assistance cash grants, the following cash pay-
ments from county agencies are exempt:
(1) Special circumstances payments provided to SSI/SSP recipients
pursuant to EAS regulations.
(2) Emergency loans provided to SSI/SSP recipients pursuant to EAS
regulations.
(3) General Relief or General Assistance payments.
(4) Cash value of food stamps.
(5) Immediate need payments provided to AFDC recipients pursuant
to EAS 40-129.
NOTE; Authority cited: Secfions 10725 and 14124.5, Welfare and Institufions
Code. Reference: Sections 14005.4 and 14005.7, Welfare and Insfitutions Code.
History
1 . New subsecfions (b)(4) and (b)(5) filed 8-8-80; effective thirtieth day thereafter
(Register 80, No. 32).
§ 50526. Work Incentive Program (WIN).
Earnings from public service employment under the WIN program are
exempt.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Secfions 14005.4 and 14005.7, Welfare and Insfitufions Code.
History
1 . New section filed 3-7-80; effective thirtieth day thereafter (Register 80, No. 9).
§ 50527. Social Services.
(a) Payments received for social services provided in accordance with
Title XX of the Social Security Act shall be exempt, whether provided
in kind or as a direct payment to the individual for purchase of designated
services. Such services include, but are not limited to:
(1) In-Home Supportive Services.
(2) Child care.
(3) Training and rehabilitation services, including payment for train-
ing expenses.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Insfitutions
Code. Reference: Secfions 14005.4, and 14005.7, Welfare and Insfitufions Code.
History
1 . Amendment of subsection (a)(1) filed 8-7-78; effective thirtieth day thereafter
(Register 78, No. 32).
2. Editorial cortecfion adding NOTE filed 6-10-83 (Register 83, No. 24).
§ 50528. Assistance Based on Need.
(a) Assistance based on need which is furnished by the State or any po-
htical jurisdiction thereof, as specified in (b), shall be exempt if the pay-
ment is all of the following:
Page 365
Register 93, No. 41; 10-8-93
§ 50529
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
(1) Made regularly on a periodic basis at least once a quarter or made
to a specific group or class of individuals in similar circumstances or situ-
ations.
(2) Made in cash, which may be currency or any negotiable instru-
ment.
(3) Issued in an amount based on the need of the individual.
(b) Assistance based on need includes payments from the following
and similar sources:
(1) Short-Doyle.
(2) Regional centers for the Developmentally Disabled.
(3) Probation departments.
(c) Payments made pursuant to public law, when the law specifically
exempts such payment from eligibility and share of cost determinations,
shall be considered assistance based on need.
NOTE; Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4 and 14005.7, Welfare and Institutions Code.
History
1 . Amendment filed 3-7-80; effective thirtieth day thereafter (Register 80, No. 9).
§ 50529. Federal Housing Assistance.
(a) Federal housing assistance in the form of rent subsidies, loans or
partial house payments under the U. S. Housing Act of 1937, the National
Housing Act, Title V of the Housing Act of 1949 or the Housing and Ur-
ban Development Act of 1965 shall be exempt.
History
1 . Amendment filed 12-15-77; effective thirtieth day thereafter (Register 77, No.
51).
§ 50530. Training Expenses.
The allowance for training expenses paid by the Department of Reha-
bilitation to persons participating in that Department's training programs
shall be exempt.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4 and 14005.7, Welfare and Institutions Code.
History
1 . New section filed as an emergency 6-1 7-80 (Register 80, No. 25). A Certificate
of Compliance must be transmitted to OAH within 120 days or emergency lan-
guage will be repealed on 10-16-80.
2. Certificate of Compliance filed 9-26-80 (Register 80, No. 39).
§ 50531 . Foster Care Payments.
(a) Payments from any source, received by a foster parent for the care
of a foster child, shall be exempt except for:
(1) The portion of the payment designated by the county department
for care and supervision, if such a designation is made.
(2) Payments made to a foster parent when a foster child is temporarily
absent from the foster home for a month or more.
(3) Payments made to ensure availability of a room or rooms for foster
children.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4, and 14005.7, Welfare and Institutions Code.
History
1 . Editorial correcnon adding NOTE filed 6-10-83 (Register 83, No. 24).
§ 50533. Exempt Loans, Grants, Scholarships and
Fellowships.
(a) The following loans, grants, scholarships and fellowships are ex-
empt:
(1) Loans made under Title III of the Federal Economic Opportunity
Act, Special Program to Combat Poverty in Rural Areas.
(2) Loans or grants to an undergraduate student for educational pur-
poses made or insured by the Federal Commissioner of Education. These
include, but are not limited to:
(A) Supplemental Education Opportunity grants.
(B) National Direct Student loans.
(C) College Work Study.
(D) Basic Educational Opportunity grants.
(E) Federal insured student loans.
(3) Educational loans or grants to undergraduate students when it is
verified that they are awarded on the basis of the student's need. These
include, but are not limited to:
(A) Extended Opportunity Program loans and grants.
(B) Bureau of Indian Affairs loans and grants.
(C) California State scholarships (Cal Grant A).
(D) College Opportunity grants (Cal Grant B).
(E) Occupational, Educational-Training grants (Cal Grant C).
(4) Funds for readers, or educational scholarships, which are all of the
following:
(A) Provided to an aged, blind or disabled person enrolled in a Califor-
nia public school or institution of higher learning.
(B) Awarded by an educational institution.
(C) Not available to tneet basic needs.
(5) Other loans, grants, scholarships or fellowships, or portions there-
of, to undergraduate or graduate students if the following conditions are
met:
(A) The loan, grant, scholarship or fellowship document specifically
limits the use of the funds for purposes other than current living costs.
(B) The loan, grant, scholarship or fellowship would not be available
if used for any purpose other than the one specified.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4, 14005.7, 11008.7, 11008.9, 11008.10 and
12152, Welfare and Institutions Code.
History
1 . Amendment of subsecfion (a) filed 12-15-77; effective thirtieth day thereafter
(Register77, No. 51).
2. Amendment filed 3-7-80; effective thirtieth day thereafter (Register 80, No. 9).
§ 50534. Payments to Victims of Crimes — Treatment as
Income.
Payments made under the California Victims of Crimes program shall
be exempt as income in the month of receipt and thereafter as property
in accordance with Section 50448, and shall not be considered to be un-
conditionally available income pursuant to Section 50186.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Institufions
Code; and Secfions 1382a(b), 1383(a)(9) and 1396a(r), Title 42, United States
Code. Reference: Sections 14005.4 and 14005.7, Welfare and Insfitufions Code
and Secfion 13959 et seq.. Government Code.
History
1 . New secfion filed as an emergency 6-17-80 (Register 80, No. 25). A Certificate
of Compliance must be transmitted to OAL within 1 20 days or emergency lan-
guage will be repealed on 10-16-80.
2. Certificate of Compliance filed 9-26-80 (Register 80, No. 39).
3. Amendment of secfion heading, text and Note filed 10-4-93; operafive
1 1-3-93 (Register 93, No. 41).
§ 50535. Relocation Assistance Benefits.
Relocation assistance benefits shall be exempt if paid by a public
agency to a person who has been relocated as a result of a program of area
redevelopment, urban renewal, freeway construction, or any other public
development involving demolition or condemnation of existing housing.
NOTE; Authority cited: Secfions 10725 and 14124.5, Welfare and InsUtutions
Code. Reference: Secfions 14005.4 and 14005.7, Welfare and Institutions Code.
History
1 . Editorial correction adding NOTE filed 6-10-83 (Register 83, No. 24).
§ 50535.5. Disaster and Emergency Assistance Payments.
Disaster and emergency assistance payments, whether in cash or in-
kind, regardless of the date of receipt, and any interest earned from such
payments, shall be exempt and shall not be included in the share of cost
computation. This exemption applies only to such payments received
from federal, state, and local government agencies, or disaster assistance
organizations.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Insfitufions
Code. Reference: Sections 14005.4 and 14005.7, Welfare and Insfitufions Code;
and 42 U.S.C. Secfions 1382a(b)(l I) and (12), 1382b(a)(6), I396a(aK10), 5121
et seq. and 5155(d).
History
1. New secfion filed 10-5-93; operafive 1 1-^1-93 (Register 93, No. 41).
Page 366
Register 9.1, No. 41; 10-8-93
Title 22
Health Care Services
§ 50543
§ 50536. Payments to Victims of the National Socialist
Persecution.
(a) Payments received from the Federal Republic of Germany (Ger-
man Reparations Payments) pursuant to the federal law on the Compen-
sation of Victims of the National Socialist Persecution (Federal Compen-
sation Law) as enacted on June 29, 1 956 shall be exempt as income in the
month received.
(b) Interest earned on German Reparations Payments shall not be ex-
empt and shall be considered countable unearned income in the month
received.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.5, and 14006, Welfare and Institutions Code,
and Program Operations Manual System SI 01120.405.
HtSTORY
1. New section filed 1 2-1 0-85; effective thirtieth day thereafter (Register 85, No.
50).
2. Amendment filed 9-4-91; operative 10-4-91 (Register 92, No. 2).
§ 50537. Federal Payments to Indians and Alaskan
Natives — Income.
(a) Payments made to Indians under Public Law 90-507 shall be con-
sidered personal property rather than income to the extent specified in
Section 50445.
(b) Per capita payments made to Indians under Section 6 of Public Law
87-775 and Public Law 92-254 shall be exempt.
(c) Per capita payments distributed pursuant to any judgment of the In-
dian Claims Commission or the Court of Claims in favor of any Indian
Tribe are exempt.
(d) Payments made to Alaskan Natives under the Alaskan Native
Claims Settlement Act are exempt. Income obtained from stock invest-
ments under the Act is not exempt.
(e) Receipts derived from lands held in trust and distributed by the fed-
eral government to members of the following Indian tribes are exempt:
(1) Bad River Bank of the Lake Superior Tribe of Chippewa Indians
of Wisconsin.
(2) Blackfeet Tribe, Blackfeet, Montana.
(3) Cherokee Nation of Oklahoma, Oklahoma.
(4) Cheyenne River Sioux Tribe, Cheyenne River, South Dakota.
(5) Crow Creek Sioux Tribe, Crow Creek, South Dakota.
(6) Lower Brule Sioux Tribe, Lower Brule, South Dakota.
(7) Devil's Lake Sioux Tribe, Fort Totten, North Dakota.
(8) Fort Belknap Indian Community, Fort Belknap, Montana.
(9) Assinboine and Sioux Tribes, Fort Peck, Montana.
(10) Lac Courte Oreilles Band of Lake Superior Chippewa Indians,
Lac Courte and Oreilles, Wisconsin.
(11) Keweenaw Bay Indian Community, L'Anse, Michigan.
(12) Minnesota Chippewa Tribe, White Earth, Minnesota.
(13) Navajo Tribe, Navajo, New Mexico.
(14) Oglala Sioux Tribe, Pine Ridge, South Dakota.
(15) Rosebud Sioux Tribe, Rosebud, South Dakota.
(16) Shoshone-Bannock Tribe, Fort Hall, Idaho.
(17) Standing Rock Sioux Tribe, Standing Rock, North and South
Dakota.
(18) Seminole Indians, Florida.
(19) Pueblos of Zia and Jemez, New Mexico.
(20) Stockbridge Munsee Indian Community, Wisconsin.
(21) Bums Indian Colony, Oregon.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4 and 14005.7, Welfare and Institutions Code.
History
1 . New subsection (e) filed as an emergency 6-17-80 (Register 80, No. 25). A Cer-
tificate of Compliance must be transmitted to OAH within 120 days or emergen-
cy language will be repealed on 10-16-80.
2. Certificate of Compliance filed 9-26-80 (Register 80, No. 39).
3. Change without regulatory of subsection (a) (Register 87, No. 11).
§ 50538. VISTA Payments.
Payments made under the Domestic Volunteer Services Act of 1973
to VISTA volunteers are exempt.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4 and 14005.7, Welfare and Institutions Code.
History
1. Editorial correction adding NOTE filed 6-10-83 (Register 83, No. 24).
§ 50539. Job Training Partnership Act (JTPA) Payments.
(a) All earnings of a child which are derived from participation in
JTPA prograiTis shall be exempt for up to six months per calendar year.
Other JTPA payments made to a child shall be exeinpt at all times.
(b) Payments, other than earnings, to an adult which are derived from
participation in JTPA programs shall be exempt to the extent that the pay-
ment reimbursements do not exceed the adult's actual training expenses.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4 and 14005.7, Welfare and Institutions Code.
History
1 . Amendment filed 3-7-80; effective thirtieth day thereafter (Register 80, No. 9).
2. Repealer and new section filed 6-3-87; operative 7-3-87 (Register 87, No. 24).
§ 50540. Executive Volunteer Programs.
Payments for supportive services or reimbursement of out-of-pocket
expenses made to persons serving in the Service Corps of Retired Execu-
tives (SCORE) and the Active Corps of Executives (ACE) pursuant to
Section 418 of Public Law 93-113 are exempt.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Insfitutions
Code. Reference: Sections 14005.4 and 14005.7, Welfare and Institutions Code.
History
1. Editorial correction adding NOTE filed 6-10-83 (Register 83, No. 24).
§ 50541 . Senior Citizen Volunteer Programs.
Compensation received by beneficiaries who are 60 years of age or
older, for volunteer services performed under the Retired Senior Volun-
teer program, the Foster Grandparents program or the Older Americans
Community Service program of the National Older Americans Act, shall
be exempt.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Secfions 14005.4 and 14005.7, Welfare and Institutions Code.
History
I. Editorial correcfion adding NOTE filed 6-10-83 (Register 83, No. 24).
§ 50542. Irregular or Infrequent Income.
(a) The first $60 of casual or inconsequent al unearned income per cal-
endar quarter shall be exempt if either of the following conditions are
met.
(1) The income is received not more than twice per quarter.
(2) The income cannot be reasonably anticipated.
(b) Earned income not exceeding $30 per calendar quarter shall be ex-
empt if either of the following conditions are met:
(1) The income is received not more than twice per quarter.
(2) The income cannot be reasonably anticipated.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Insfitufions
Code. Reference: Secfions 14005.4 and 14005.7, Welfare and Institufions Code.
History
1. Amendment filed 12-1 5-77; effecfive thirtieth day thereafter (Register 77, No.
51).
2. Editorial correcfion adding NOTE filed 6-10-83 (Register 83, No. 24).
§ 50543. Student Exemption.
(a) All earned income, including earnings from JTPA after the six
months' exemption pursuant to Section 50539 has expired, of an AFDC-
MN or MI child shall be exempt if the child is either of the following:
(1) A full-time student.
(2) A part-time student with a school schedule that is equal to at least
one-half of a full-time curriculum, and the child is not employed full-
time.
(b) For purposes of this exemption the following definitions apply:
(1) School attendance means enrollment and attendance in a school,
college, university, or in a course of vocational or technical training de-
Page 367
Register 93, No. 41; 10-8-93
§ 50543.5
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
signed to fit the child for gainful employment and includes participation
in the Job Corps program under the Economic Opportunity Act.
(2) Full-time student means a student who has a school schedule equal
to a full-time curriculum, as defined by the school attended.
(3) Part-time employment means employment for less than 1 73 hours
per month.
(c) The student exemption shall also apply to full or part-time earnings
between school terms or during vacation periods, if the child plans to con-
tinue school attendance during the next term or when the vacation period
ends.
NOTE; Authority cited: Sections 10725 and 14124.5. Welfare and Institutions
Code. Reference: Sections 14005.4 and 14005.7, Welfare and Institutions Code.
History
1. Amendment of subsection (b) filed 12-15-77; effective thirtieth day thereafter
(Register77, No. 51).
2. Editorial correction adding NOTE filed 6-10-83 (Register 83, No. 24).
3. Amendment of subsection (a) filed 6-3-87; operative 7-3-87 (Register 87, No.
24).
§ 50543.5. Earned Income Tax Credit.
(a) The actual Earned Income Tax Credit (EITC) payment shall be ex-
empt as income whether received as a tax refund or an advance payment.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14005.7, Welfare and Institutions Code; Sections
402(a)(8)(A)(viii), 161 2b, 1613a and 1902r(2) Social Security Act (42 U.S.C. Sec-
tions 602, 1382a(b), 1382b(a) and 1382a(r)(2)).
History
1. New section filed 9-28-89 as an emergency; operative 10-1-89 (Register 89,
No. 40). A Certification of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 1-29-90.
2. Certificate of Compliance as to 9-28-89 order including amendment trans-
mitted to OAL 1-26-90 and filed 2-21-90 (Register 90, No. 9).
3. Amendment of section heading, text and Note filed 2-2-93; operative 3^^93
(Register 93, No. 6).
§ 50544. Earnings of Children Under Age 14.
Earnings of children under 14 years of age shall be exempt.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4, and 14005.7, Welfare and Institutions Code.
History
1. Editorial correction adding NOTE filed 6-10-83 (Register 83, No. 24).
§ 50545. Deductions from Income.
The deductions specified in Sections 50547 through 50555.2 shall be
deducted from nonexempt income in the sequence presented in these reg-
ulations to determine net nonexempt income.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; and Section 57(c), Chapter 328, Statutes of 1982. Reference: Sections
14005.4 and 14005.7, Welfare and Institutions Code.
History
1. Amendment filed 8-18-82 as an emergency; effective upon filing (Register 82,
No. 34). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 12-16-82.
2. Certificate of Compliance transmitted to OAL 12-16-82 and filed 1-21-83
(Register 83, No. 4).
3. Editorial correction of NOTE filed 4-12-83 (Register 83, No. 16).
§ 50547. Educational Expenses.
(a) Documented educational expenses for college or similar training
courses which are incurred by a beneficiary shall be deducted either from
any income received for educational purposes, as defined in (b), or from
any loan received for educational purposes, which is considered as prop-
erty in accordance with Section 50483(b). Such educational expenses
shall be apportioned over the period of time they are intended to cover
to determine the monthly deduction. Documented expenses incurred by
the beneficiary include any of the following items or services necessary
for school attendance:
(1) Tuition.
(2) Books.
(3) Fees.
(4) Equipment and supplies.
(5) Special clothing needs.
(6) Child care services.
(7) Costs of transportation to and from school based on the mode most
economically available and feasible in the particular circumstances. If it
is determined that personal car usage meets these criteria, all actual trans-
portation costs will be prorated based on the percentage of miles driven
to and from school to total miles driven each month. Allowable transpor-
tation costs include, but are not limited to. car payments, car insurance
and registration, and gasoline.
(b) Income for educational purposes includes, but is not limited to:
(!) Exempt student loans, grants or fellowships, as identified in Sec-
tion 50533.
(2) Nonexempt student loans, grants or fellowships which do not re-
quire repayment.
(3) Social Security and Veteran's Administration payments to a child
attending school which are based on a deceased or disabled parent's en-
titlement.
(4) Veterans Educational Assistance program payments (GI Bill).
(c) The beneficiary educational expenses shall first be deducted from
the totally exempt loans or grants identified in Section 50533. Any re-
maining educational expenses shall next be deducted from other loans for
educational purposes, that are considered property in accordance with
Section 50483(b), and finally from other income received for educational
purposes.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4 and 14005.7, Welfare and Institutions Code.
History
1. Amendment of subsections (a) and (b) filed 12-15-77; effective thirtieth day
thereafter (Register 77, No. 51).
2. Amendment filed 3-7-80; effective thirtieth day thereafter (Register 80, No. 9).
3. Repealer of subsection (a)(6) and renumbering of subsection (a)(7) to (a)(6)
filed 4-2-82 as an emergency; effective upon filing (Register 82, No. 14). A
Certi ficate of Compliance must be transmitted to OAL within 1 20 days or emer-
gency language will be repealed on 7-31-82.
4. Certificate of Compliance transmitted to OAL within 120 days and filed
8-10-82 (Register 82, No. 33)
5. New subsecfion (a)(7) filed 6-3-87; operative 7-3-87 (Register 87, No. 24).
§ 50549. Deductions from Income — MFBUs Which Include
Aged, Blind or Disabled MN Persons.
The deductions in Section 50549.1 through 5055 1.() shall be sub-
tracted from nonexempt income of MFBUs which include aged, blind or
disabled MN persons. These deductions are apphed only if a member of
the MFBU applies and is found eligible as aged, blind or disabled. Each
deduction shall apply only to the income specified in the section which
defines that deduction.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Secfions 14005.3, 14005.7 and 14005.14, Welfare and Institu-
tions Code.
History
1. Amendment filed 2-7-78 as an emergency; effective upon filing (Register 78,
No. 6).
2. Certificate of Compliance filed 5-5-78 (Register 78, No. 18).
3. Amendment filed 1-20-81 as an emergency; effective upon filing (Register 81,
No. 4). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 5-19-81.
4. Order of Repeal of 1-20-81 order filed 1-29-81 by OAL pursuant to Govern-
ment Code Section 11349.6(Register 81, No. 4).
5. Editorial Correction of Order of Repeal filed 1-30-81 (Register 81, No. 4).
6. Amendment filed 1 1-4-81 ; effective thirtieth day thereafter (Register 81, No.
45).
7. Editorial correcfion of NOTE filed 6-10-83 (Register 83, No. 24).
§ 50549.1. Support Payment from an Absent Parent.
One-third of any payment made by an absent parent for the support of
a disabled or blind child shall be deducted from the total payment.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.3 and 14005.7, Welfare and Institutions Code.
History
I. Editorial correction adding NOTE filed 6-10-83 (Register 83, No. 24).
Page 368
Register 9:^, No. 41; 10-8-93
Title 22
Health Care Services
§ 50551
§ 50549.2. Any Income Deduction — Unearned Income.
(a) Twenty dollars shall be deducted from the combined nonexempt
unearned income of all aged, blind or disabled MN persons and the
spouse or parents of these persons.
(b) That portion of the allowable $20 deduction which is in excess of
the combined nonexempt unearned income shall be subtracted from tiie
combined nonexempt earned income in accordance with Section
50551.2.
(c) The provisions of this regulation also apply to eligibility determi-
nations or redeterminations made retroactively to January 1, 1977.
History
1 . Amendment filed 2-7-78 as an emergency; effective upon filing (Register 78,
No. 6).
2. Certificate of Compliance filed 5-5-78 (Register 78, No. 18).
§ 50549.3. Guardian and Conservator Fees.
(a) Reasonable court approved guardian/conservator fees shall be al-
lowed as a deduction to the unearned income of an aged, blind, or dis-
abled medically needy person if all of the following conditions are met:
(1) The fees are paid to a court-appointed guardian or conservator of
an individual who has been declared by a court to be substantially unable
to manage his/her own financial resources and then only to the extent the
fees are actually owed in the month in which the payment is made.
(2) A court-appointed guardian or conservator is required by the entity
paying the unearned income as a condition of rendering payment to in-
competent persons.
(3) The guardian or conservator provides a signed statement from the
entity making such payment verifying the requirement set forth in (a)(2).
(b) Payments rendered by the Social Security Administration or other
entity to incompetent persons which may be made to a representative
payee or other similar individual regardless of guardian/conservator sta-
tus, shall not be considered to meet tlie conditions specified in subsection
(a)(2).
(c) When the conditions set forth in subparagraph (a) are not met, the
unearned income of an aged, bhnd, or disabled medically needy person
which is used to pay reasonable or court ordered guardian/conservator
fees shall be considered available in accordance with section 505 1 3.
NOTE: Authority cited: Sections 10725, 14124.5(a) and 14154.2(b), Welfai-e and
Insfitutions Code; 42 CFR Section 435.831 ; and 42 U.S.C. Secfion ]396a(r). Ref-
erence: 20 CFR Sections 416.601 and 416.1 123(b)(3): 42 U.S.C. Section
1383(a)(2)(A).
History
1 . New section filed 1 1-2-90 as an emergency; operative 1 1-2-90 (Register 90,
No. 50). A Certificate of Compliance must be transmitted to OAL by 3-4-91
or emergency language will be repealed by operation of law on the following
day.
2. Certificate of Compliance as to 1 1-2-90 order including amendments trans-
mitted to OAL 3-1-91 and filed 4-1-91 (Register 91, No. 16).
§ 50551 . Student Deduction.
(a) A maximum of $1,620 per year shall be deducted from the nonex-
empt earned income of a blind or disabled person who is all of the follow-
ing:
(1) Underage 22.
(2) Not now married.
(3) Not a parent.
(4) Enrolled or will be enrolled in school for at least eight hours a week
during one month of either the following:
(A) Current calendar quarter.
•
[The next page is 369.]
Page 368.1
Register 93, No. 41; 10-8-93
Title 22
Health Care Services
§ 50551.6
•
(B) Next calendar quarter.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.3 and 14005.7, Welfare and Institutions Code.
History
1. Repealer and new section filed 2-7-78 as an emergency; effective upon filing
(Register 78, No. 6).
2. Certificate of Compliance filed 5-5-78 (Register 78, No. 18).
3. Editorial correction adding NOTE filed 6-10-83 (Register 83, No. 24).
4. Change without regulatory effect of subsection (a)(4) (Register 87, No. 1 1).
§ 50551 .1 . Thirty Dollars Plus One-Third— MFBUs Which
Include Aged, Blind or Disabled MN Persons.
(a) The first $30 plus one-third of the remainder shall be deducted
from the nonexempt earned income of an AFDC-MN or MI person, if the
person meets all of the following:
(1) Is the spouse or parent of an aged, blind or disabled MN person.
(2) Was eligible for and receiving an AFDC cash grant, as specified
in (b) from any state, in one of the four months immediately prior to the
month in which the deduction will be applied.
(3) Did not receive the $30 plus one-third deduction in any AFDC
cash family budget unit for four consecuti ve months without an interven-
ing twelve consecutive month period when he/she was not an AFDC re-
cipient.
(b) A person is considered to have been receiving an AFDC cash grant
if that person meets any of the following conditions:
(1) Was receiving an AFDC money payment.
(2) Was not receiving an AFDC money payment due to the adjustment
of an overpayment.
(c) When the beneficiary has received the $30 plus one-third deduc-
tion in any MFBU or AFDC Assistance Unit for four consecutive months
as provided in (a) above, he/she shall be eligible for a $30 disregard for
a period of eight consecutive months immediately following the end of
the four consecutive months.
(d) If for any reason the beneficiary does not receive the $30 deduction
in a month that month shall nonetheless count as one of the eight consecu-
tive months.
(e) When the additional eight consecutive month period has expired,
a beneficiary shall not be entitled to receive either the $30 plus one-third
or the $30 deduction again until he/she has not received AFDC for twelve
consecutive months.
(f) The provisions of this regulation also apply to eligibility determina-
tions or redeterminations made retroactively to October 1, 1984.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Institutions
Code; Section 14, AB 1557, Chapter 1447, Statutes of 1984. Reference: Sections
14005.4, 14005.7 and 14005.8, Welfare and Insfitutions Code.
History
1. Repealer and new secfion filed 2-7-78 as an emergency; effecfive upon filing
(Register 78, No. 6).
2. Certificate of Comphance filed 5-5-78 (Register 78, No. 18).
3. Amendment filed 4-2-82 as an emergency; effective upon filing (Register 82,
No. 14). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 7-31-82.
4. Certificate of Compliance transmitted to OAL within 120 days and filed
8-10-82 (Register 82, No. 33).
5. Amendment of subsection (a)(2) and new subsections (c), (d), (e), and (f) filed
4-15-85 as an emergency (Register 85, No. 16). A Certificate of Compliance
must be transmitted to OAL within 120 days or emergency language will be re-
pealed on 8-13-85.
6. Certificate of Compliance including amendment of subsecfions (c)-(e) trans-
mitted to OAL 8-13-85 and filed 9-18-85 (Register 85, No. 38).
§ 50551.2. Any Income Deduction — Earned Income.
(a) That portion of the income deduction specified in Section 50549.2
which is in excess of the nonexempt unearned income shall be subtracted
from the combined nonexempt earned income of aged, blind or disabled
MN persons and the spouse or parents of these persons.
(b) The provisions of this regulation also apply to eligibility determi-
nations or redeterminations made retroactively to January 1, 1977.
History
1 . Amendment filed 2-7-78 as an emergency; effective upon filing (Register 78,
No. 6).
2. Certificate of Compliance filed 5-5-78 (Register 78, No. 1 8).
3. Change without regulatory effect of subsection (a) (Register 87, No. 11).
§ 50551 .3. Sixty-Five Plus One-Half.
(a) The first $65 plus one-half of the remainder shall be deducted from
the combined nonexempt earned income of all aged, blind or disabled
MN persons and the spouse or parents of these persons.
(b) The provisions of this regulation also apply to ehgibihty determi-
nations or redeterminations made retroactively to January 1, 1977.
History
1. Amendment filed 2-7-78 as an emergency; effective upon filing (Register 78,
No. 6).
2. Certificate of Compliance filed 5-5-78 (Register 78, No. 18).
§ 50551 .4. Work Expenses of the Blind.
In addition to the deduction in Section 50551 .3 the actual cost of work
related expenses shall be deducted from the nonexempt earned income
of a blind person.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institufions
Code. Reference: Sections 14005.3 and 14005.7, Welfare and Institutions Code.
History
1. Editorial correction adding NOTE filed 6-10-83 (Register 83, No. 24).
§ 50551 .5. Income Necessary to Achieve Self-Support.
(a) Nonexempt earned or unearned income of a bhnd or disabled per-
son shall be deducted, if such income is needed to implement a plan of
self-support which meets all of the following criteria:
( 1 ) Is in writing.
(2) Was initiated and approved while the person was receiving SSI/
SSP.
(3) Has not been subsequently abandoned.
§ 50551 .6. Cost of In-Home Supportive
Services— ABD-MN and SGA Disabled.
(a) The amount actually paid for in-home supportive services pro-
vided to any ABD-MN person, or to a SGA-disabled person as defined
in Section 50223(a)(2) shall be deducted from the combined nonexempt
income of the SGA-disabled or ABD-MN person and the responsible
relative, except as limited by (b), (c) and (d).
(b) The cost of in-home supportive services (IHSS) shall be a deduc-
tion only when all of the following conditions are met:
(1) The services are provided by a person other than a family member
living in the home.
(2) The services have been determined to be necessary pursuant to an
IHSS needs assessment described in Section 50169(b), and:
(3) The costs for these services have been reduced by any veterans
benefit designated as an Aid and Attendance payment.
(c) In-home supportive services means those services which may be
provided under the IHSS program.
(d) For ABD-MN persons, the provisions of this section shall be lim-
ited to persons who, without in-home supportive services, would require
24-hour-a-day care in a health facility or community care facility as evi-
denced by a statement signed by a physician.
NOTE: Authority cited: Sections 10725, 14005. Hand 14124.5, Welfare and Insti-
tutions Code; and Section 2, Chapter 364, Statutes of 1984. Reference: Sections
14005.3 (Section 1, Chapter 1 156, Statutes of 1979), 14005.14 and 14024, Wel-
fare and Institutions Code.
History
1. New section filed 1-20-81 as an emergency; effective upon filing (Register 81,
No. 4). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 5-19-81.
2. Order of Repeal of 1-20-81 order filed 1-29-81 by OAL pursuant to Govern-
ment Code Secfion 1 1349.6 (Register 81 , No. 4).
3. New secfion filed ll^t-81; effecfive thirtieth day thereafter (Register 81, No.
45).
4. Amendment filed 5-30-85 as an emergency; effective upon filing (Register 85,
No. 22). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 9-27-85.
Page 369
(4-1-90)
§ 50553
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
5. Ceitificate of Compliance transmitted to OAL 9-24-85 and filed JO-24-85
(Register 83, No. 43).
6. Amendment of subsection (b) filed 2-16-88 as an emergency; operative
2-16-88(Register88.No. 10). A Certificate of Compliance must be transmitted
to OAL within 120 days or emergency language will be repealed on 6-15-88.
7. Emergency language filed 2-16-88 repealed by operation of Government Code
Section 1 1346.1 (Register 88, No. 27).
8. Amendment of subsection (b) refiled 6-22-88 as an emergency; operative
6-22-88 (Register 88, No. 27). A Certificate of Compliance must be transmitted
to OAL within 120 days or emergency language will be repealed on 10-20-88.
9. Certificate of Compliance transmitted to OAL 6-20-88 and filed 7-15-88
(Register88, No. 31).
§ 50553. Deductions from Earned Income — AFDC-MN, Ml
or Ineligible Members of the MFBU.
(a) The deductions specified in Sections 50553.1 through 50553.5
shall be subtracted in sequence from the nonexempt gross earned income
of each AFDC-MN or MI persoris, or persons who are ineligible mem-
bers of the MFBU, except as specified in (b).
(b) An AFDC-MN or MI person, or an ineligible member of the
MFBU, who is included in the same MFBU as the person's aged, blind
or disabled MN spouse or child shall not receive the deductions specified
in Sections 50553.1 through 50553.5.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4 and 14005.7, Welfare and Institutions Code;
and Section 402 (a)(8)(iii). Social Security Act (42 U.S.C. Section 602).
History
1. Amendment filed 2-7-78 as an emergency; effective upon filing (Register 78,
No. 6).
2. Certificate of Compliance filed 5-5-78 (Register 78, No. 18).
3. Amendment filed 2-1 1-82; effective thirtieth day thereafter (Register 82, No.
7).
4. Amendment of subsection (a) filed 4-2-82 as an emergency; effective upon fil-
ing (Register 82, No. 14). A Certificate of Compliance must be transmitted to
OAL within 120 days or emergency language will be repealed on 7-31-82.
5. Certificate of Compliance transmitted to OAL within 120 days and filed
8-10-82 (Register 82, No. 33).
6. Amendment filed 9-28-89 as an emergency; operative 10-1-89 (Register 89,
No. 40). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 1-29-90.
7. Certificate of Compliance as to 9-28-89 order transmitted to OAL 1-26-90 and
filed 2-21-90 (Register 90, No. 9).
§ 50553.1 . Deduction for Work Expenses.
(a) Ninety dollars for mandatory deductions and work related ex-
penses shall be deducted from the earned income of each AFDC-MN and
MI person.
(b) The provisions of this regulation also apply to eligibility determi-
nations or redeterminations made retroactively to October 1, 1989.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institufions
Code. Reference: Sections 14005.4 and 14005.7, Welfare and Institutions Code;
and Section 402 (a) (8) (ii). Social Security Act (42 U.S.C. Section 602).
History
1. Amendment filed 2-7-78 as an emergency; effective upon filing (Register 78,
No. 6).
2. Certificate of CompHance filed 5-5-78 (Register 78, No. 18).
3. Amendment of subsection (a) and repealer of subsection (e) filed 8-8-80;effec-
tive thirtieth day thereafter (Register 80, No. 32).
4. Repealer and new section filed 4-2-82 as an emergency; effective upon filing
(Register 82, No. 14). A Certificate of Compliance must be transmitted to OAL
within 120 days or emergency language will be repealed on 7-31-82.
5. Certificate of Compliance transmitted to OAL within 120 days and filed
8-10-82 (Register 82, No. 33).
6. Amendment filed 4-1 5-85 as an emergency; effective upon filing (Register 85,
No. 16). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 8-13-85.
7. Certificate of Compliance as to 4-1 5-85 order transmitted to OAL 8-1 3-85 and
filed 9-18-85 (Register 85, No. 38).
8. Amendment filed 9-28-89 as an emergency; operative 10-1-89 (Register 89,
No. 40). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 1-29-90.
9. Certificate of Compliance as to 9-28-89 order transmitted to OAL 1-26-90 and
filed 2-21-90 (Register 90, No. 9).
§ 50553.2. Deduction for Dependent Care.
NOTE: Authority cited: Secdons 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4 and 14005.7, Welfare and Institutions Code.
History
1. Repealer and new section filed 4-2-82 as an emergency; effective upon filing
(Register 82, No. 14). A Certificate of Compliance must be transmitted to OAL
within 120 days or emergency language will be repealed on 7-31-82.
2. Repealer of subsection (b)(2) filed 7-16-82 as an emergency; effective upon
filing (Register 82, No. 29). A Certificate of Compliance must be transmitted
to OAL within 120 days or emergency language will be repealed on 1 1-13-82.
3. Certificate of Compliance as to 4-2-82 order transmitted to OAL within 120
days and filed 8-10-82 (Register 82, No. 33).
4. Certificate of Compliance as to 7-16-82 order transmitted to OAL within 120
days and filed 8-10-82 (Register 82, No. 33).
5. New subsecdon (b)(2) filed 12-8-83; effective thirtieth day thereafter (Register
83, No. 50).
6. Renumbering and amendment of former Secdon 50553.2 to Secdon 50553.5
filed 9-28-89 as an emergency; operative 10-1-89 (Register 89, No. 40). A
Certificate of Compliance must be transmitted to OAL within 1 20 days or emer-
gency language will be repealed on 1-29-90.
7. Certificate of Compliance as to 9-28-89 order transmitted to OAL 1-26-90 and
filed 2-21-90 (Register 90, No. 9).
§ 50553.3. Thirty Dollars Plus One-Third.
(a) Thirty dollars of nonexeinpt earned income of each AFDC-MN or
Ml person, plus one-third of the remainder, shall be deducted if the per-
son who is earning the income meets both of the following conditions:
(1) Was eligible for and receiving an AFDC cash grant, as specified
in (b), from any state in one of the four months immediately prior to the
month in which the deduction will be applied.
(2) Did not receive the $30 plus one-third deduction in any AFDC
cash family budget unit for four consecutive months without an interven-
ing twelve consecutive month period when he/she was not an AFDC re-
cipient.
(b) A person is considered to have been receiving an AFDC cash grant
if that person meets any of the following conditions:
(1) Was receiving an AFDC money payment.
(2) Was not receiving an AFDC payment due to the adjustment of an
overpayment.
(c) When the beneficiary has received the $30 plus one-third deduc-
tion in any MFBU or AFDC Assistant Unit for four consecutive months
as provided in (a) above, he/she shall be eligible for a $30 disregard for
a period of eight consecutive months immediately following the end of
the four consecutive months.
(d) If for any reason the beneficiary does not receive the $30 deduction
in a month that month shall nonetheless count as one of the eight consecu-
tive months.
(e) When the additional eight consecutive month period has expired,
a beneficiary shall not be entitled to receive either the $30 plus one-third
or the $30 deduction again until he/she has not received AFDC for twelve
consecutive months.
(f) The provisions of this regulation also apply to eligibihty determina-
tions or redetenninadons made retroactively to October 1, 1984.
NOTE: Authority cited: Secdons 10725 and 14124.5, Welfaie and InsUtudons
Code; Section 14, Chapter 1447, Statutes of 1984. Reference: Secdons 14005.4,
14005.7 and 14005.8, Welfare and Insdtudons Code.
History
1 . Amendment filed 12-1 5-77; effective thirtieth day thereafter (Register 77, No.
51).
2. Repealer and new secdon filed 4-2-82 as an emergency; effective upon filing
(Register 82, No. 14). A Certificate of Compliance must be transmitted to OAL
within 120 days or emergency language will be repealed on 7-31-82.
3. Certificate of Compliance transmitted to OAL within 120 days and filed
8-10-82 (Register 82, No. 33).
4. New subsecdons (c), (d), (e), and (f) filed 4-15-85 as an emergency; effective
upon filing (Register 85, No. 16). A Certificate of Compliance must be trans-
mitted to OAL within 120 days or emergency language will be repealed on
8-13-85.
5. Certificate of Compliance as to 4-1 5-85 order transmitted to OAL 8-1 3-85 and
filed 9-18-85 (Register 85, No. 38).
Page 370
(4-1-90)
Title 22
Health Care Services
§ 50555.3
•
§ 50553.5. Deduction for Dependent Care.
(a) The amount as determined in accordance with (b) shall be deducted
from the remaining earned income of an AFDC-MN or Ml person when
both of the following conditions exist:
(1) The person has reasonable and necessary costs of obtaining child
care for a child in the MFBU or care for an incapacitated person in the
MFBU.
(2) The county department determines that adequate dependent care
cannot be provided by another member of the MFBU.
(b) The amount deducted in accordance with (a) shall be the actual
amount paid as limited by the following:
(1) A maximum of $200 per child under two years of age.
(2) A maximum of $ 175 per child two years of age or older.
(3) A maximum of $175 per incapacitated person.
(c) This deduction shall also apply when the care is provided by a
member of the MFBU, other than a spouse or parent, who terminated em-
ployment specifically to provide the necessary care.
(d) The provisions of this regulation also apply to eligibility determi-
nations or redeterminations made retroactively to October 1, 1989.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4 and 14005.7, Welfare and Institutions Code;
and Sections 402(a)(8)(iii) and 1 902 (r)(2), Social Security Act (42 U.S.C. Section
602).
History
1. Renumbering of former Section 50553.2 to Section 50553.5, and amendment
of subsections (b) and (d) filed 9-28-89; operative 10-1-89 (Register 89, No.
40). A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on 1-29-90.
2. Certificate of Compliance as to 9-28-89 order transmitted to OAL 1-26-90 and
filed 2-21-90 (Register 90, No. 9).
§ 50554. Court Ordered Alimony or Child Support.
(a) Court ordered alimony or child support, or child support paid pur-
suant to an agreement with a district attorney, shall be deducted from the
income of an AFDC-MN or MI beneficiary when it is actually paid by
that beneficiary.
(b) The amount deducted shall be the lesser of the amount:
(1) Actually paid.
(2) Specified in the court order or agreement with a district attorney.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4 and 14005.7, Welfare and Institutions Code.
History
1 . New section filed 1-8-8 1 ; effective thirtieth day thereafter (Register 81, No. 2).
§ 50554.5. Child/Spousal Support Received by AFDC-MN
and Ml Family Members.
(a) Fifty dollars per month shall be deducted from the child/spousal
support received by AFDC-MN and MI family members, whether pro-
vided voluntarily or by court order, when received and due in the current
month.
(b) Fifty dollar for each month shall be deducted from child support
received by AFDC-MN and MI family members for past months if both
of the following conditions are met:
(1) The payments for past months are received by the family member
in the current month.
(2) The payments were made by the absent parent in the month the pay-
ment was due.
(c) Child support payments shall be considered to meet the conditions
described in (b) only in cases where the absent parent makes payment as
described and required in a court order, agreement with the district attor-
ney, voluntary payment schedule, or other such document which esta-
blishes a duty to pay child support and includes but is not limited to cases
where one of the following conditions is met:
(1) The agreement or court order specifies a payment schedule which
requires annual, semi-annual, quarterly or other multiple month pay-
ments for reasons other than payment of past due amounts.
(2) Payment is made but not received due to circumstances beyond the
control of both the absent parent and the AFDC-MN or MI family mem-
ber. Such circumstances include, but are not limited to the following:
(A) Payment is made timely to the district attorney or court and not
passed on to the AFDC-MN or MI person until a subsequent month.
(B) Payment for each month is made through payroll deduction or gar-
nishment of wages and is not forwarded to the AFDC-MN or MI person
until the subsequent month.
(d) The provisions of this regulation also apply to eligibility determi-
nations or redeterminations made retroactively to October 1, 1989.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4, 14005.7 and 14005.8, Welfare and Institu-
tions Code; and Section 402(a)(8)(A)(vi), Social Security Act (42 U.S.C. Section
602).
History
1. Renumbering and amendment of Secrion 50524 to Section 50554.5 filed
7-9-87; operative 8-8-87 (Register 87, No. 30).
2. Amendment of subsections (a) and (b), and new subsections (c) and (d) filed
9-28-89 as an emergency; operative 10-1-89 (Register 89, No. 40). A Certifi-
cate of Compliance must be transmitted to OAL within 120 days or emergency
language will be repealed on 1-29-90.
3. Certificate of Compliance as to 9-28-89 order transmitted to OAL 1-26-90 and
filed 2-21-90 (Register 90, No. 9). %
§ 50555. Deductions from Any Income — All MN or Ml
Programs.
The deductions specified in Sections 50555.1 through 50555.2 shall
be subtracted from any nonexempt income that remains after the applica-
tion of all preceding exemptions and deductions.
Note: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4 and 14005.7, Welfare and Institutions Code.
History
1 . Amendment filed 8-1 8-82 as an emergency; effective upon filing (Register 82,
No. 34). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 12-16-82.
2. Editorial con-ection of NOTE filed 4-12-83 (Register 83, No. 16).
3. Editorial con-ecfion of NOTE filed 6-10-83 (Register 83, No. 24).
§ 50555.1. Income of an MN or Ml Person Used to
Determine Public Assistance Eligibility of
Another Family Member.
(a) That portion of the income of an MN or MI person or a person re-
sponsible for the MFBU which is counted in determining the eligibility
of a spouse, parent or child as a PA or Other PA recipient shall be de-
ducted.
(b) Income of a stepparent and the value of income in kind provided
by a stepparent which is counted in determining the eligibility of a spouse
or stepchildren as PA or Other PA recipients shall be deducted.
History
1 . Amendment filed 12-15-77; effecdve thirtieth day thereafter (Register 77, No.
51).
§ 50555.2. Health Insurance Premiums.
(a) Health insurance premiums shall be deducted if paid by and pur-
chased for any person in the family.
(b) Health insurance payments paid less often then monthly shall be
averaged on a monthly basis.
(c) The premium for Part B Medicare shall be deducted for those
months in which the beneficiary actually makes the payment, notwith-
standing Section 50773(b).
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4 and 14005.7, Welfare and Institutions Code.
History
1. Editorial correcfion adding NOTE filed 6-10-83 (Register 83, No. 24).
§ 50555.3. Court Ordered Child Support.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4 and 14005.7, Welfare and Institutions Code.
History
1. Repealer filed 1-8-81; effective thirtieth day thereafter (Register 81, No. 2).
Page 371
(4-1-90)
§ 50555.4
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
§ 50555.4. Special Deduction for Aged, Blind or Disabled
MN.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; and Section 57(c), Chapter 328, Statutes of 1982. Reference: Section 8.
Chapter 328, Statutes of 1982.
HtSTORY
1 . Amendment of subsection (a)(2) filed 12-15-77; effective thirtieth day thereaf-
ter (Register 77, No. 51).
2. Repealer filed 8-1 8-82 as an emergency; effective upon filing (Register 82. No.
34). A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on 12-16-82.
3. Certificate of Compliance transmitted to OAL 12-16-82 and filed 1-21-83
(Register 83, No. 4).
§ 50557. Treatment of Income.
(a) The following income shall be considered in determining the share
of cost of a person or family:
(1) Net nonexempt income of all persons included in the MFBU in ac-
cordance with Section 50371 through 50381.
(2) Income specified in Sections 50558 through 50564.
(b) That portion of the income of persons excluded from the MFBU
as PA or Other PA recipients which was used to determine their PA or
Other PA eligibihty shall not be considered. Ail income of persons eligi-
ble for four months or nine months continuing eligibility shall be consid-
ered.
NOTE; Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; Section 14, Chapter 1447, Statutes of 1984. Reference: Sections 14005.4,
14005.7 and 14005.8, Welfare and Institutions Code.
History
1. Amendment of subsection (b) filed 12-15-77; effective thirtieth day thereafter
(Register77, No. 51).
2. Amendment of subsection (a)(2) filed 1-5-78 as an emergency; effective upon
filing (Register 78, No. 1).
3. Certificate of compliance filed 5-5-78 (Register 78, No. 18).
4. Amendment filed 1-8-81; effective thirtieth day thereafter (Register 81, No. 2).
5. Amendment of subsection (b) filed 4-15-85 as an emergency; effective upon
filing (Register 85, No. 16). A Certificate of Compliance must be transmitted
to OAL within 120 days or emergency language will be repealed on 8-13-85.
6. Certificate of Compliance as to 4-1 5-85 order transmitted to OAL 8-13-85 and
filed 9-18-85 (Register 85, No. 38).
§ 50558. Income of Persons Excluded from the MFBU.
(a) The income of children excluded from the MFBU shall not be
counted in determining the share of cost for the MFBU.
(b) In addition to their own income, children excluded from the MFBU
shall be allocated an amount to meet their combined need, which shall be
determined as follows, unless the condition of (c) is met:
(1) Determine the maintenance need for the MFBU with the children
included.
(2) Determine the maintenance need for the MFBU with the children
excluded.
(3) Subtract the amount determined in (2) from the amount determined
in(l).
(4) Subtract the net nonexempt income of all excluded children from
the amount determined in (3). This is the amount that shall be allocated
to the children excluded from the MFBU.
(c) The income of the members of a stepparent unit who are excluded
from the MFBU shall be treated in accordance with Sections 50559 and
50561.
NOTE: Authority cited: Sections 10725 and 14124, Welfare and Institufions Code.
Reference: Secfions 14005.4, 14005.7 and 14008, Welfare and Institufions Code.
History
1. Amendment filed 1-8-81 ; effecfive thirtieth day thereafter (Register 81, No. 2).
§ 50559. Income Deemed Available from the Stepparent.
(a) If there is a stepparent living in the home and only the parent and
the parent's separate children are included in the MFBU, the income
deemed available from the stepparent shall be determined as follows:
(1) Combine the stepparent's nonexempt unearned income with the
stepparent's gross earned income minus the deduction for work expenses
specified in Section 50553.1.
(2) Deduct, from the ainount determined in (I ), the following amounts:
(A) Amounts actually paid by the stepparent to persons not living in
the home but who are claimed as dependents for purposes of determining
the stepparent's Federal personal income tax liability.
(B) Voluntary or court-ordered child support and alimony payments
made by the stepparent to persons not living in the home.
(C) The maintenance need for the stepparent unit which includes the:
1 . Stepparent.
2. Mutual children.
3. Stepparent's children.
(3) The remainder, if any, is income available to the MFBU.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code: and Secfion 5, Chapter 1 221 , Statutes of 1985. Reference: Sections 14005.4,
14005.7 and 14005.16, Welfare and Institutions Code.
History
1 . Amendment filed 1 -8-8 1 ; effective thirtieth day thereafter (Register 8 1 , No. 2).
2. Amendment filed 2-1 1-82: effecfive thirtieth day thereafter (Register 82, No.
7).
3. Repealer and new section filed 4-2-82 as an emergency; effecfive upon filing
(Register 82, No. 14). A Certificate of Compliance mustbe transmitted to OAL
within 120 days or emergency language will be repealed on 7-31-82.
4. Certificate of Compliance transmitted to OAL within 120 days and filed
8-10-82 (Register 82, No. 33).
5. Amendment filed 12-2-85 as an emergency; effective upon filing (Register 85,
No. 50). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 4-1-86.
6. Amendment refiled 3-28-86 as an emergency; effective upon filing (Register
86, No. 1 3). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 7-28-86.
7. Reinstatement of section as it existed prior to emergency amendment filed
3-28-86 by operaUon of Government Code Secfion 11346.1(0 (Register 86,
No. 23).
§ 50561 . Treatment — Stepparent Cases.
(a) If there is a stepparent living in the home, and only the parent and
the parent' s separate children are included in the MFBU, the income con-
sidered in determining the share of cost of those children shall be:
( 1 ) The income of the children.
(2) The income of the parent.
(3) The income available from the stepparent as determined in accor-
dance with Section 50559.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Insfitufions
Code; and Secfion 5, Chapter 1221, Statutes of 1 985. Reference: Sections 14005.4,
14005.7, 14008 and 14005.16, Welfare and Insfitufions Code.
History
1. Amendment filed 1-8-81 ; effective thirtieth day thereafter (Register 8 1, No. 2).
2. Amendment filed 12-2-85 as an emergency; effecfive upon filing (Register 85,
No. 50). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 4—1-86.
3. Amendment refiled 3-28-86 as an emergency; effecfive upon filing (Register
86, No. 3). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 7-28-86.
4. Reinstatement of secfion as it existed prior to emergency amendment filed
3-28-86 by operafion of Government Code Secfion 11346.1(f) (Register 86,
No. 23).
§ 50563. Treatment of Income — Aged, Blind or Disabled
MN Person or Person's Spouse in LTC or
Board and Care.
(a) When an aged. Wind or disabled MN person or the spouse of that
person is in LTC or board and care and that person has a spouse and/or
children who are not Public Assistance recipients, the income of that per-
son shall be treated in the following manner, beginning the first of the
month the spouses, or the parent and children, are in separate MFBUs:
(1) The net nonexempt income of the person in LTC or board and care
which is in excess of the appropriate maintenance need for that person
in accordance with the provisions of Article 1 1 of this chapter shall be
allocated to the spouse and/or children as follows:
Page 372
(4-1-90)
Title 22
Health Care Services
§ 50570
•
•
(A) When the family is applying for Medi-Cal, determine the mainte-
nance need for the spouse and/or children other than any children ex-
cluded from the MFBU.
(B) When only the person in LTC or board and care is applying for
Medi-Cal, determine the maintenance need for the spouse and/or all the
children.
(C) Subtract the net nonexempt income of the spouse and/or children,
other than the excluded children, from the amount determined in (A) or
(B). This is the amount that shall be allocated to the spouse and/or chil-
dren from the net nonexempt income of the MN person in LTC or board
and care which is in excess of the maintenance need as determined in (1 ).
(2) If the person in LTC or board and care is a stepparent:
(A) The stepchildren shall be treated as natural children of the person
in LTC or board and care.
(B) The allocation shall be determined in accordance with (1).
(b) In no event shall any income be allocated from the family members
living at home to the person in long-term care or board and care.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.1, 14005.4, 14005.7, 14008, Welfaie and Insti-
tutions Code.
History
) . Amendment filed 1-28-77 as an emergency; effective upon filing (Register 77,
No. 5).
2. Certificate of Compliance filed 4-22-77 (Register 77, No. 17).
3. Amendment filed 3-7-80; effective thirtieth day thereafter (Register 80, No. 9).
4. Amendment filed 1-8-81 ; effective thirtieth day thereafter (Register 81 , No. 2).
5. Amendment of subsection (a), repealer of subsection (b) and relettering of sub-
section (c) to subsecfion (b) filed 8-18-82 as an emergency; effective upon fil-
ing (Register 82, No. 34). A Certificate of Compliance must be transmitted to
OAL within 120 days or emergency language will be repealed on 12-16-82.
6. Certificate of Comphance transmitted to OAL 12-16-82 and filed 1-21-83
(Register 83, No. 4).
7. Editorial correction of subsecfions (a)(1) and (a)(2)(A) filed 1-21-83 (Register
83, No. 4).
8. Amendment of subsecfion (a) filed 7-9-87; operative 8-8-87 (Register 87, No.
30).
§ 50564. Treatment of Income — Persons No Longer
Receiving Title XVI Due to a Cost of Living
Increase In OASDI Benefits Under Title II.
(a) The provisions of this section shall be applied to any MFBU which
includes an aged, blind or disabled person who meets all of the following
conditions:
(1) Was eligible for and receiving Title XVI benefits in any month
since April 1977.
(2) Was in receipt of OASDI Title II benefits and received a cost of liv-
ing increase since April 1977.
(3) Has not been entitled to Title XVI benefits in any month since re-
ceipt of a Title II cost of living increase, including the month of receipt
of the Title II increase.
(4) Would be entitled to Title XVI benefits, as determined in accor-
dance with Department procedures, if the Title II cost of living increases
received after Title XVI ineligibility occurred are disregarded. Increases
to be disregarded include the increase which rendered Title XVI ineligi-
bility.
(b) The aged, blind or disabled person in the MFBU who meets all of
the conditions specified in (a) shall be eligible for Medi-Cal as a Title II
Disregard person with no share of cost.
(c) The net nonexempt income of the Title II Disregard person shall
be considered when determining the share of cost for the remaining fami-
ly members.
(d) The Title II Disregard person shall be considered a member of the
MFBU when determining the maintenance need in accordance with Sec-
tion 50601.
(e) The share of cost for the MFBU shall be processed in accordance
with Section 50660.
(0 The provisions of this regulation also apply to eligibility determina-
tions or redeterminations made retroactively to September 1, 1978.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14005.7, Welfare and Institutions Code.
History
1 . New section filed 1-5-78 as an emergency; effective upon filing (Register 78,
No. 1).
2. Certificate of Compliance filed 5-5-78 (Register 78, No. 18).
3. New subsection (c) filed 6-30-78 as an emergency; effective upon filing (Reg-
ister 78, No. 26).
4. Amendment filed 5-24-79 as an emergency; designated effective 6-1-79 (Reg-
ister 79, No. 21).
5. Certificate of Compliance filed 9-19-79 (Register 79, No. 38).
§ 50565. Projection of Anticipated Income.
NOTE: Authority cited: Sections 10725, 14005.9(c) and 14124.5, Welfare and In-
stitutions Code, Section 1 33.5, AB 25 1 , Chapter 1 02, Statutes of 1 98 1 . Reference:
Section 14005.9, Welfare and Institutions Code.
History
1 . Amendment filed 12-1 5-77; effective thirtieth day thereafter (Register 77, No.
51).
2. Repealer and new section filed 1 1-30-81 as an emergency; effective upon filing
(Register 81 , No. 49). A Certificate of Compliance must be transmitted to OAL
within 120 days or emergency language will be repealed on 3-30-82.
3. Certificate of Compliance filed 3-30-82 (Register 82, No. 14).
4. Repealer filed 10-1-82 as an emergency; effecfi ve upon filing (Register 82, No.
40). A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on 1-29-83.
5. Certificate of Comphance transinitted to OAL 12-30-82 and filed 2-2-83
(Register 83, No. 6).
§ 50567. Adjustment for Decreases in Income.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Insfitutions
Code; Section 133.5, AB 251, Chapter 102, Statutes of 1981. Reference: Section
14005.9, Welfare and Institutions Code.
Hlstory
1. Repealer filed 11-30-81 as an emergency; effective upon filing (Register 81,
No. 49). A Certificate of Compliance must be transmitted to OaL within 120
days or emergency language will be repealed on 3-30-82.
2. Certificate of Compliance filed 3-30-82 (Register 82, No. 14).
§ 50569. County Failure to Change Income.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Insfitutions
Code; Section 133.5, AB 251, Chapter 102, Statutes of 1981. Reference: Section
14005.9, Welfare and Institutions Code.
History
1. Repealer filed 1 1-30-81 as an emergency; effective upon filing (Register 81,
No. 49). A Certificate of Compliance must be transmitted to OaL within 120
days or emergency language will be repealed on 3-30-82.
2. Certificate of Compliance filed 3-30-82 (Register 82, No. 14).
§ 50570. Income Determination and Limit for the Qualified
Medicare Beneficiary (QMB) or the Specified
Low-Income Medicare Beneficiary (SLMB).
(a) To determine the eligibility of an adult, couple, or child for the
QMB program, net nonexempt income shall not exceed 90% of the offi-
cial poverty level in 1990, 100% of the official poverty level in 1991 and
thereafter, as defined by the federal Office of Management and Budget,
and revised annually in accordance with section 673(2) of the Omnibus
Budget Reconciliation Act of 1981. Income attributable to a Title II cost
of living adjustment is excluded according to federal law.
(b) To determine the eligibility of an adult, couple, or child for the
SLMB program, net nonexempt income shall not exceed 1 1 0% in 1993
and 1994, rising to 120% in 1995 and ongoing of the official poverty level
in each year as defined by the federal Office of Management and Budget
in accordance with Section 4501 of the Omnibus Budget Reconciliation
Act of 1990. Income attributable to a Title II cost of living adjustment
is excluded according to federal law.
(c) Net nonexempt income shall first be determined in accordance with
all the applicable provisions of Article 8 and Article 10, except that the
health insurance premiums as specified under Section 50555.2 are not al-
lowed and the deduction for IRWE as defined in Section 50045.1 is al-
lowed.
(d) If ineligibility results from the computadon under (c) above, the net
nonexempt income then will be determined following SSI methodology
specified in Section 1612, Title XVI of the federal Social Security Act.
NOTE: Authority cited: Secfions 10725, 14005.1 1 and 14124.5, Welfare and Insfi-
tutions Code; and Section 12, Chapter 1430, Statutes of 1989. Reference; Sections
1396a(a)(10)(E)(iii) and 1396d(p), Title 42, United States Code; Section 4501,
Page 373
Register 95, No. 14; 4-7-95
§ 50571
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
Omnibus Budget Reconciliation Act of 1990, Public Law 101-308; and Section
14005.1 i, Weffare and Institutions Code.
History
1. New section filed 8-13-90 as an emergency; operative 8-13-90 (Register 90,
No. 40). A Certificate of Compliance must be transmitted to OAL by 12-1 1-90
or emergency language will be repealed by operation of law on the following
day.
2. Certificate of Compliance including amendment transmitted to OAL 12-11-90
and filed 1-9-91 (Register 91, No. 8).
3. Amendment of section heading, new subsection (b) and subsection redesigna-
tion, and amendment of newly desisnated subsections (c)-(d) and Note filed
12-21-93; operative 1-20-94 (Register 93, No. 52).
§ 50571 . Income Determination and Limit for the Qualified
Disabled and Working Individual (QDWI).
(a) To qualify for the QDWI Program, the net nonexempt income of
a QDWI applicant/beneficiary cannot exceed 200 percent of the federal
poverty level.
(b) Net nonexempt income shall be determined following SSI method-
ology specified in Section 1612, Title XVI of the federal Social Security
Act.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Insfitutions
Code; and Section 12, Chapter 1430, Statutes of 1989. Reference: Section
14005.3, Welfare and Institutions Code; and Secfions 1396a(a)(10)(E) and
1396d(s), Title 42, United States Code.
History
L New section filed 10-3-94 as an emergency; operative 10-3-94 (Register 94,
No. 40). A Certificate of Compliance must be transmitted to OAL by 1-31-95
or emergency language will be repealed by operation of law on the following
day.
2. Editorial correction of History Note 1 (Register 95, No. 9).
3. Repealed by operation of Government Code section 1 1346.1(g) (Register 95,
No. 9).
4. New secdon refiled 3-3-95 as an emergency; operative 3-3-95 (Register 95,
No. 9). A Certificate of Compliance must be transmitted to OAL by 7-1-95 or
emergency language will be repealed by operation of law on the following day.
5. Certificate of Compliance as to 3-3-95 order including amendment of Note
transmitted to OAL 2-22-95 and filed 4-5-95 (Register 95, No. 14).
Article 11. Maintenance Need
§ 50601 . Maintenance Need — General.
(a) The amount of income a person or family is allowed to retain for
living expenses shall be determined by adding the following:
(1) The maintenance need for the members of the MFBU living in the
home as determined in accordance with Section 50603.
(2) The maintenance need for the members of the MFBU in long-term
care as determined in accordance with Section 50605.
§ 50603. Maintenance Need — Persons Living in the Home.
(a) The maintenance need for members of the MFBU living in the
home shall be determined in the following manner with amounts of 1 cent
or more rounded to the next highest dollar.
(1) The maintenance need for an MFBU consisting of one individual
shall equal 80 percent of the AFDC payment level for a family of two per-
sons multiphed by 133 1/3 percent.
(2) The maintenance need for an MFBU consisting of two adults shall
equal the AFDC payment level for a family of three persons multiplied
by 133 1/3 percent.
(3) The maintenance need for an MFBU consisting of two persons
when one or both persons are not adults and for an MFBU consisting of
three through ten persons shall equal 133 1/3 percent of the AFDC pay-
ment level for a family group of corresponding size.
(4) The monthly maintenance need determined in accordance with (1)
through (3) shall be calculated on an annual basis, rounded to the next
higher multiple of $100, and then prorated.
(5) The maintenance need for an MFBU consisting of 1 1 or more per-
sons shall equal the maintenance need level for a family group of 10 es-
tablished in accordance with (3) and (4) plus an amount equal to the
AFDC MBS AC increase level for additional persons in excess of 10 for
each MFBU member in excess of 10.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; and Section 124.7, Chapter 323, Statutes of 1983. Reference: Sections
14005.12 and 14008, Welfare and Institutions Code.
History
1. Repealer and new section filed 8-18-82 as an emergency; effective upon filing
(Register 82, No. 34). A Certificate of Compliance must be transmitted to OAL
within 1 20 days or emergency language will be repealed on 1 2-1 6-82. For prior
history, see Register 82, No. 13.
2. New section refiled 12-16-82 as an emergency; effective upon filing (Register
82, No. 51). A Certificate of Compliance must be transmitted to OAL within 1 20
days or emergency language will be repealed on 4-15-83.
3. Certificate of Compliance as to 8-18-82 and 12-16-82 orders transmitted to
OAL 12-31-82 and filed 2-1-83 (Register 83, No. 6).
4. Amendment of subsection (a) and repealer of subsections (b) and (c) filed
2-1-83; effective upon filingpursuani to GoveiTiment Code Section 11346.2(d)
(Register 83, No. 6).
5. Amendment filed 11-17-83 as an emergency; effective upon filing (Register
83, No. 49). A Certificate of Comphance must be transjnitted to OAL within 1 20
days or emergency language will be repealed on 3-17-84.
6. Certificate of Compliance as to 11-17-83 order transmitted to OAL 3-16-84
and filed 4-17-84 (Register 84, No. 16).
§ 50604. Maintenance Need — Family Members Maintaining
Separate Residences with Eligibility
Determined As a Single MFBU.
(a) An MFBU which includes a child who maintains a separate resi-
dence from his/her parent(s) in accordance with Section 50351(c) shall
be assigned a combined maintenance need to be calculated according to
(1) through (3).
(1) In accordance with Section 50603, determine the maintenance
need for the separate household of the child as follows:
(A) For one child living alone or one child sharing a residence with
other persons not financially responsible for the child, use the mainte-
nance need level for one person established in accordance with Section
50603(a).
(B) For two or more children who are living together and who are
claimed as dependents by the parent(s) for tax purposes, use the mainte-
nance need level for the corresponding number of persons established in
accordance with Section 50603(a).
(C) For two or more children who live alone in separate residences, use
the maintenance need level for one for each child established in accor-
dance with Section 50603(a).
(D) For a married child living with his/her spouse, use the maintenance
need level for two established in accordance with Section 50603(a).
(2) Determine the maintenance need for the parent's household in ac-
cordance with Section 50603.
(3) Combine the maintenance need determined in (1) and (2). This is
the total maintenance need for the entire MFBU.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; Section 57(c), Chapter 328, Statutes of 1982; and Secdon 87(c), Chapter
1594, Statutes of 1982. Reference: Sections 14005.12 and 14008, Welfare and In-
stitutions Code.
History
1. New secfion filed 10-1-82 as an emergency; effective upon filing (Register 82,
No. 40). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 1-29-83.
2. New subsection (a)(1)(D) filed 12-21-82 as an emergency; effective upon fil-
ing (Register 82, No. 52). A Certificate of Compliance must be transmitted to
OAL within 120 days or emergency language will be repealed on 4-20-83.
3. Certificate of Compliance as to 10-1-82 order transmitted to OAL 1 -28-83 and
filed 2-28-83 (Register 83, No. 10).
4. Amendment of subsection (a)(l )(A)-(C) filed 2-28-83; effective thirtieth day
thereafter (Register 83, No. 10).
5. Certificate of Compliance as to 12-21-82 order including amendment of sub-
section (a)(1)(D) transmitted to OAL 4-19-83 and filed 5-16-83 (Register 83,
No. 21).
§ 50605. Maintenance Need — Persons in Long-Term Care.
(a) The maintenance need for a member of the MFBU in long-term
care shall be either of the following:
(1) Thirty-five dollars for personal and incidental needs, when the
beneficiary will remain in long-term care for the entire calendar month.
(2) For individuals with therapeutic wages, thirty-five dollars plus an
additional amount equal to either a) 70 percent of the gross therapeutic
earnings; or, b) 70 percent of the maintenance need level allowed for a
Page 374
Register 95, No. 14; 4-7-95
Title 22
Health Care Services
§ 50653
•
noninstitutionalized person or family of corresponding size, as described
in Section 50603, whichever is less.
(A) The provisions of subsection (a)(2) of this regulation also apply
to eligibility determinations or redeterminations made retroactively to
October 1,1984.
(3) The appropriate maintenance need determined in accordance with
Section 50603, if the person will be in long-term care for only a portion
of the month.
(b) An LTC patient shall retain an amount of income for upkeep of a
home in addition to the amount specified for personal and incidental
needs in (a) (1) if all of the following conditions are met.
(1) The spouse or family of the LTC patient is not living in the home.
(2) The home, whether rented or owned by the LTC patient, is actually
being maintained for the return of the LTC patient.
(3) There is a verified medical determination that the LTC patient will
return home within six months of the date LTC patient status was estab-
lished.
(c) The amount allowed for upkeep of the home, if the conditions spe-
cified in (b) are met, shall be:
(1) One hundred thirty-three and one-third percent of the income in
kind value of housing for one person pursuant to Section 5051 1(a) and
(b), if the applicant or beneficiary has been living alone in the home.
(2) One hundred thirty-three and one-third percent of the income in
kind value of housing for 2 persons pursuant to Section 5051 1(a) and (b)
divided by 2, if the home is shared with persons for whom the applicant
or beneficiary has no legal responsibility for support.
(3) One hundred thirty-three and one-third percent of the income in
kind value of housing for 2 persons pursuant to Section 505 1 1 (a) and (b)
divided by 2 for each spouse, if the beneficiary and spouse have been liv-
ing together and both have become LTC patients and will return home
within six months.
(4) The amount allowed for upkeep of the home as determined accord-
ing to (1) through (3) shall be calculated on an annual basis, rounded to
the next higher multiple of $100, and then prorated.
(d) The LTC patient shall also retain an amount of income to pay for
the support of a disabled relative if all the of following conditions are met.
(1) The disabled relative is not the LTC patient's:
(A) Spouse.
(B) Child, as defined in Section 50030.
(2) The LTC patient has contributed and will continue to contribute to
the support of the disabled relative on a regular basis.
(e) The amount allowed for the support of a disabled relative, if the
conditions specified in (d) are met, shall be the lesser of:
(1) The actual amount contributed.
(2) The maintenance need level for one person established in accor-
dance with Section 50603(a)(1), minus the disabled relative's net in-
come.
NOTE: Authority cited: Sections 10725, 14005.13 and 14124.5, Welfare and Insti-
tutions Code. Reference: Sections 14005.12 and 14005.13, Welfare and Institu-
tions Code.
History
1 . Amendment of subsections (c) and (e) filed 8-18-82 as an emergency; effective
upon filing (Register 82, No. 34). A Certificate of Compliance must be trans-
mitted to OAL within 120 days or emergency language will be repealed on
12-16-82. For prior history, see Register 82, No. 13.
2. Amendment of subsections (c) and (e) refiled 12-16-82 as an emergency; effec-
tive upon filing (Register 82, No. 51). A Certificate of Compliance must be
transmitted to OAL within 120 days or emergency language will be repealed on
4-15-83.
3. Certificate of Compliance as to 8-18-82 and 12-16-82 orders transmitted to
OAL 12-31-82 and filed 2-1-83 (Register 83, No. 6).
4. Amendment of subsections (c) and (e)(1) filed 2-1-83; effective upon filing
pursuant to Government Code Section 1 1346.2(d) (Register 83, No. 6).
5. Amendment of subsections (c) and (e) filed 1 1-17-83 as an emergency; effec-
tive upon filing (Register 83, No. 49). A Certificate of Compliance must be
transmitted to OAL within 1 20 days or emergency language will be repealed on
3-17-84.
6. Certificate of Compliance as to 11-17-83 order transmitted to OAL 3-16-84
and filed 4-17-84 (Register 84 No. 16).
7. Amendment of subsection (a)(1) filed 4-4-85 as an emergency; effective upon
filing (Register 85, No. 15). A Certificate of Compliance must be transmitted
to OAL within 120 days or emergency language will be repealed on 8-2-85.
8. Amendment of subsection (a)(2) filed 8-9-85 as an emergency, effective on fil-
ing (Register 85, No. 32). A Certificate of Compliance must be transmitted to
OAL within J 20 days or emergency language will be repealed on 12-9-85.
9. Certificate of Compliance as to 4-4-85 order transmitted to OAL 7-30-85 and
filed 8-29-85 (Register 85, No. 36).
10. Certificate of Compliance as to 8-9-85 order transmitted to OAL 1 1-13-85
and filed 12-1 1-85 (Register 85, No. 50).
1 1. Amendment of subsection (c) filed 4-16-86; effective thirtieth day thereafter
(Register 86, No. 16).
Article 12. Share of Cost
§ 50651 . Share of Cost— GeneraL
Share of cost shall be determined and processed in accordance with the
requirements of this article.
§ 50652. Share of Cost Period.
NOTE: Authority cited: Sections 10724. 10725, 14005.9(c) and 14124.5, Welfare
and Institutions Code; Section 1 33.5, AB 251, Chapter 1 02, Statutes of 1981 . Ref
erence: Secnon 14005.9, Welfaie and Institutions Code.
History
1. New section filed 11-30-81 as an emergency; effective upon filing (Register
81, No. 49). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 3-30-82.
2. Certificate of Compliance filed 3-30-82 (Register 82, No. 14).
3. Repealer filed 10-1-82 as an emergency; effective upon filing (Register 82, No.
40). A Certificate of Compliance must be transmitted to OAL within 120 days
or emergency language will be repealed on 1-29-83.
4. Certificate of Compliance transmitted to OAL 12-30-82 and filed 2-2-83
(Register 83, No. 6).
§ 50653. Determination of Share of Cost.
(a) The share of cost shall cover a one month period and be determined
as follows:
(1) For MFBUs which do not include a person in LTC:
(A) Determine the net nonexempt income available to the members of
the MFBU.
(B) Round the total net nonexempt income determined in (A) to the
nearest dollar, with amounts ending in 50 cents or more rounded to the
next higher dollar.
(C) Determine the appropriate maintenance need for the MFBU in ac-
cordance with Section 50603.
(D) Subtract the combined maintenance need from the total rounded
net nonexempt income. The remainder, if any, is the share of cost.
(2) For MFBUs which include a person in LTC:
(A) Determine the total countable income available to the MFBU in
the month.
(B) Add to the total countable income any amounts previously de-
ducted in accordance with Sections 50547 through 50554.
(C) Subtract from the amount determined in (B) the deductions and al-
locations specified in Sections 50555.1 through 50555.4 and 50563. This
is the net nonexempt income available to the MFBU.
(D) Round the total net nonexempt income determined in (C) to the
nearest dollar, with amounts ending in 50 cents or more to the next high-
est dollar.
(E) Determine the appropriate maintenance need in accordance with
Section 50601.
(F) Subtract the amount determined in (E) from the amount deter-
mined in (D). This amount, if any, is the share of the cost.
(b) The share of cost shall be determined:
(1) At the time of application, reapplication or restoration.
(2) When there is a change in income, family composition or any other
factor affecting the share of cost. In these instances the share of cost shall
be determined in accordance with Sections 50653.3 and 50655.5.
NOTE: Authority cited: Sections 10725, 14005.9(c) and 14124.5, Welfare and In-
stitutions Code; Section 133.5, AB 251, Chapter 102, Statutes of 1981 . Reference:
Sections 14005.4, 14005.7 and 14005.9, Welfare and Institutions Code.
Page 375
Register 94, No. 40; 10-7-94
§ 50653.3
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
History
1. Amendment of subsection (b)(2) filed 8-8-80; effective thirtieth day thereafter
(Register 80, No. 32).
2. Amendment filed 1-8-81 ; effective thirtieth day thereafter (Register 81 , No. 2).
3. Amendment filed 7-31-81 as an emergency; effecfive upon filing (Register 81 ,
No. 33). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 1 1-28-81 .
4. Amendment filed 1 1-30-81 as an emergency; effective upon filing (Register
8 1 , No. 49). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 3-30-82.
5. Amendment of subsection (a)(2) filed 12-23-81; effective thirtieth day thereaf-
ter (Register 81, No. 52).
6. Certificate ofCompliance as to 7-3 1-81 order transmitted to OAL 1 1-6-81 and
filed 1-27-82 (Register 82, No. 5).
7. Certificate of Compliance as to 11 -30-81 order filed 3-30-82 (Register 82. No.
14).
8. Amendment of subsection (a) filed 10-1-82 as an emergency; effective upon
filing (Register 82, No. 40). A Certificate ofCompliance must be transmitted
to OAL within 120 days or emergency language will be repealed on 1-29-83.
9. Certificate of Compliance transmitted to OAL 12-30-82 and filed 2-2-83
(Register 83, No. 6).
10. EdUorial cortection of NOTE filed 4-12-83 (Register 83, No. 16).
§ 50653.3. Changes Which Decrease the Share of Cost.
(a) In situations where a change in income or other circumstances,
which results in a decrease in the share of cost is reported by the benefi-
ciary in a timely manner, as specified in Section 50185, the county de-
partment shall:
(1) Make the necessary changes in the ongoing share of cost by the first
of the month following the month in which the change was reported.
(2) Determine what the share of cost should have been for the month
in which the change occurred.
(3) Implement the beneficiary's choice of either of the following:
(A) Having an adjustment made in future months in accordance with
(c) for the months in which income in excess of the correct share of cost
was paid or obligated toward medical bills.
(B) Having the correct Form MC 177S or Medi-Cal card with a share
of cost issued and processed for the months in which the share of cost
should have been lower.
(b) In situations where a change in income or other circumstances,
which results in a decrease in the share of cost, is not reported by the bene-
ficiary in a timely manner, as specified in Section 50185, the county de-
partment shall:
( 1 ) Make the necessary changes in the ongoing share of cost by the first
of the month following the month in which the change was reported.
(2) Not make an adjustment for the excess income the beneficiary may
have paid or obligated prior to county action specified in (b)(1) unless the
county department determines that there was good cause for failure to re-
port in a timely manner. Good cause shall be determined in accordance
with Section 50175.
(c) When it is determined in accordance with (a) or (b) that there has
been a decrease in the share of cost which is to be adjusted, the adjustment
shall be made in accordance with the following:
(1) The period of adjustment shall begin with the month the county de-
partment takes action in accordance with (a) or (b), and shall terminate
when the total adjustment has been made.
(2) The amount of the adjustment is the difference between the original
share of cost and the corrected share of cost.
(3) The amount of the adjustment or a portion of the adjustment equal
to the share of cost shall be subtracted from the share of cost each month
until the adjustment is completed.
NOTE: Authority cited: Secfions 10725, 14005.9 and 14124.5, Welfare and Insti-
tutions Code; Secfion 133.5, AB 251, Chapter 102, Statutes of 1981. Reference:
Secfions 14005.4, 14005.7 and 14005.9, Welfare and Institufions Code.
History
1. New section filed 11-30-81 as an emergency; effecfive upon filing (Register
81 , No. 49). A Certificate ofCompliance must be transmitted to OAL within 1 20
days or emergency language will be repealed on 3-30-82.
2. Certificate ofCompliance filed 3-30-82 (Register 82, No. 14).
3. Amendment of subsections (a) and (b) filed 10-1-82 as an emergency; effective
upon filing (Register 82, No. 40).
4. Certificate of Compliance transmitted to OAL 12-30-82 and filed 2-2-
(Register83, No. 6).
5. Editorial correction of NOTE filed 4-12-83 (Register 83, No. 16).
83
§ 50653.5. Changes Which increase the Share of Cost.
(a) Except as described in Section 50262.3, in situations where a
change in income or other circumstances, which result in an increase in
the share of cost, is reported by the beneficiary in a timely manner, as spe-
cified in Section 50185, the county department shall make necessary
changes effective:
(1) Immediately, if the increase is due to the voluntary inclusion of a
family member who has income. The share of cost to be met shall be ei-
ther of the following:
(A) The total increased share of cost shall be met by all members of
the MFBU providing Medi-Cal cards have not been issued to the MFBU
for the share-of-cost month and form MC 177S has not been submitted
to the Department in accordance with Section 50658(c).
(B) The difference between the increased share of cost and the former
share of cost shall be met by the newly included family member(s) when
Medi-Cal cards have been issued to the MFBU for the share-of-cost
month or form MC 177S has been submitted to the Department in accor-
dance with Section 50658(c).
(2) In accordance with the following, in all other instances:
(A) The first of the month following the month in which the change
was reported, if a 10 day notice can be given.
(B) The first of the second month following the month in which the
change was reported, if the change cannot be made in accordance with
(A).
(b) In situations where a change in income or other circumstances,
which results in an increase in the share of cost determination, is not re-
ported by the beneficiary in a timely manner, as specified in Section
50185, the county department shall:
(1) Make the changes to the ongoing share of cost in accordance with
(a).
(2) Determine what the share of cost should have been for the months
in which the beneficiary should have had a share of cost or an increased
share of cost.
(3) Report a potential overpayment in accordance with Section 50783
which incorporates 50781, if the beneficiary:
(A) Received a Medi-Cal card and should have had a share of cost.
(B) Met a share of cost which was less than the corrected share of cost.
NOTE: Authority cited: Secfions 10725, 14016.10and 14124.5, Welfare and Insti-
tutions Code. Reference: Sections 14005.9 and 14009, Welfare and Insfitutions
Code.
History
1. New section filed 1 1-30-81 as an emergency; effective upon filing (Register
81 , No. 49). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 3-30-82.
2. Certificate of Compliance filed 3-30-82 (Register 82, No. 14).
3. Amendment filed 10-1-82 as an emergency; effecfive upon filing (Register 82,
No. 40). A Certificate ofCompliance must be transmitted to OAL within 120
days or emergency language will be repealed on 1-29-83.
4. Certificate of Compliance transmitted to OAL 12-30-82 and filed 2-2-83
(Register 83, No. 6).
5. Amendment of subsection (a)(1) filed 7-9-87; operative 8-8-87 (Register 87,
No. 30).
6. Amendment of subsecfions (b)(2) and (b)(3) and Note filed 4-13-93; operative
5-13-93 (Register 93, No. 16).
7. Amendment of subsection (a) and Note filed 4-27-94 as an emergency; opera-
tive 4-27-94 (Register 94, No. 1 7). A Certificate of Compliance must be trans-
mitted to OAL by 8-25-94 or emergency language will be repealed by opera-
tion of law on the following day.
8. Certificate ofCompliance as to 4-27-94 order transmitted to OAL 8-24-94 and
filed 9-29-94 (Register 94, No. 39).
9. Editorial cortection of Note (Register 94, No. 39).
Page 376
Register 94, No. 40; 10-7-94
Title 22
Health Care Services
§ 50655
•
§ 50653.7. Changes in Share of Cost Determination Due to
Administrative Error.
(a) An administrative error which causes the share of cost amount to
be in excess of the correct share of cost amount shall be adjusted in accor-
dance with Section 50653.3(a).
(b) If the county fails to take action on an increase in income within
the time frames specified in Section 50653.5, excess income received af-
ter the time the county department should have taken action shall not be
reported as a potential overpayment.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; Section 133.5, AB 251, Chapter 102, Statutes of 1981. Reference: Section
14005.9, Welfare and Institutions Code.
History
1. New section filed 1 1-30-81 as an emergency; effective upon filing (Register
81 , No. 49). A Certificate of Compliance must be transmitted to OAL within 1 20
days or emergency language will be repealed on 3-30-82.
2. Certificate of Compliance filed 3-30-82 (Register 82, No. 14).
§ 50655. Record of Health Care Costs— Share of Cost.
(a) The Record of Health Care Costs— Share of Cost, iform MC 177S,
shall be used to verify that health care costs have been obligated or paid
by the beneficiary in an amount equal to the share of cost. The form shall
be used for all beneficiaries who have a share of cost, except as specified
in (b).
(b) Form MC 177S shall not be used for beneficiaries who meet both
of the following conditions:
(1) Are in long-term care.
(2) Have a share of cost which is less than or equal to the monthly cost
of care at the Medi-Cal reimbursement rate for the long-term care facil-
ity.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; and Section 57(c), Chapter 328, Statutes of 1982. Reference: Sections
14005.4, 14005.7, 14005.9, 14006 and 14019.6, Welfare and Institutions Code.
History
1. Amendment filed 8-8-80; effective thirtieth day thereafter (Register 80, No.
32).
•
[The next page is 377.]
•
Page 376.1
Register 94, No. 40; 10-7-94
Title 22
Health Care Services
§ 50658
•
2. Amendment filed 8-18-82 as an emergency; effective upon filing (Register 82,
No. 34). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 12-16-82.
3. Certificate of Compliance transmitted to OAL 12-14-82 and filed 1-21-83
(Register 83, No. 4).
4. Change without regulatory effect of subsection (a) (Register 87, No. 11).
§ 50657. Completion of Form MC 177S.
(a) Form MC 177S shall be completed as follows:
(1) The identifying information shall be completed by the county de-
partment. The only persons who shall be listed on form MC 177S as eligi-
ble to have the cost of their health services used to tneet the share of cost
are those:
(A) Eligible members of the MFBU in accordance with Sections
50373, 50375 and 50377.
(B) Ineligible members of the MFBU in accordance with Section
50379.
(2) Form MC 177S shall be issued to the beneficiary for each month
during which the beneficiary must meet a share of cost.
(A) For continuing beneficiaries, form MC 1 77S shall be issued prior
to the first day of the month of eligibility.
(B) For new and restored beneficiaries, form MC 177S shall be issued
at the time the approval notice of action is issued.
(3) The beneficiary shall present form MC 177S to each provider when
the cost of services provided will be used to meet the share of cost.
(4) The provider will list on the form MC 177S health services which
have been provided and meet all of the following criteria.
(A) Were provided in the month specified on form MC 177S. Services
are considered to have been provided in the month if the date of service
is within the month. The date of service for:
1. Health services provided under a Global BiUing Agreement is the
date the last service under the agreement is rendered or the date of deliv-
ery, if the global billing is for pregnancy and delivery.
2. Dental prosthesis, prosthetic and orthotic appliances, and eye
appliances is the date the item is actually ordered from the fabricating
laboratory.
3. Prescription drugs is the date the item was actually received.
4. All other health services is the date the service was actually ren-
dered.
(B) Have not been submitted as a claim against the Medi-Cal program.
(C) Have not been paid by Medicare, other health coverage, or any oth-
er party, and the provider for the amounts listed on form MC 177S.
(5) For each service listed the provider shall include:
(A) The date of service, in accordance with (a) (4) (A).
(B) The total cost of the service provided.
(C) The amount billed to the patient.
(D) The patient Medi-Cal identification number.
(E) Either of the following:
1. For Medi-Cal program covered services, the procedure/drug code
for the service provided.
2. For other services, a description of the service provided, such as in-
patient, drug or dental.
(F) The Medi-Cal provider number or provider license number.
(6) The provider shall sign a declaration under penalty of perjury that:
(A) Each service listed on form MC 177S was provided to the person
listed on the date specified.
(B) Payment for the amount listed in the Billed Patient column will be
sought from the patient and not from the Medi-Cal program or a third-
party payor.
(7) When the amount in the Billed Patient column of form MC 177S
equals or exceeds the share of cost, the beneficiary or the beneficiary's
representative shall:
(A) Sign the form indicating that the beneficiary has assumed legal re-
sponsibility for the amount shown in the Billed Patient column.
(B) Return the form to the county department.
(b) For purposes of this section, the following definitions shall apply:
(1 ) Provider means the person or entity which provides health services
to the persons listed on form MC 177S and which is a Medi-Cal provider
or a hcensed practitioner meeting the criteria of a Medi-Cal provider in
accordance with Article 3, Chapter 3.
(2) Health services means the medical services, social services, sup-
plies, devices, drugs and any other medical care provided to a person
listed on form MC 177S by a provider as defined in (b)(1).
NOTE; Authority cited: Sections 10725, 14005.9 and 14124.5, Welfare and Insti-
tutions Code; Section 133.5, AB 251, Chapter 102, Statutes ori981 ; and Section
57(c), Chapter 328. Statutes of 1 982; and Section 1 4, AB 1 557, Chapter 1 447, Stat-
utes of 1984. Reference: Sections 14005. 14005.4. 14005.7. 14005.8, 14005.9,
14018, 14019 and 14019.6, Welfare and Institutions Code.
History
1. Amendment of subsection (a)(1)(A) filed 4-15-85 as an emergency; effective
upon filing (Register 85, No. 16). A Certificate of Compliance must be trans-
mitted to OAL within 120 days or emergency language will be repealed on
8-13-85. For prior history, see Register 83, No. 16.
2. Certificate of Compliance including amendment of subsection (a)(1)(A) trans-
mitted to OAL 8-13-85 and filed 9-18-85 (Register 85, No. 38).
3. Amendment filed 7-3-86; effective thirtieth day thereafter (Register 86, No.
27).
§ 50658. Form MC 177S Processing.
(a) When the share of cost has been met, the beneficiary shall return
the signed form MC 177S to the county department. The county depart-
ment shall review form MC 177S to ensure that:
(1) The case description portion of the form is complete.
(2) The services listed were provided to persons listed on form MC
177S.
(3) The providers have completed the form in accordance with Section
50657(a)(4) through (6).
(4) The beneficiary or the beneficiary's representafive has signed the
form.
(b) If the items specified above are not completed correctly, the fol-
lowing action shall be taken:
(1) The county department shall attempt to obtain the information nec-
essary for completion of form MC 177S verbally from either of the fol-
lowing:
(A) The beneficiary.
(B) The provider.
(2) If the information necessary to correct form MC 177S cannot be
obtained verbally the county department shall:
(A) Identify the information needed.
(B) Return the form to the beneficiary.
(3) When the amount shown in the Billed Patient column is in excess
of the share of cost amount, the county department shall:
(A) Explain to the beneficiary that the amount shown in the Billed Pa-
tient column is the amount for which he has assumed legal responsibility.
(B) Attempt to correct the error in accordance with (b) (1) and (2) if
the beneficiary states that the assumption of legal responsibility for the
cost of services in excess of the share of cost was not intentional.
(c) After form MC 177S has been determined to be correct and com-
plete, the following action shall be taken, unless the conditions specified
in (d) are met.
(1) The first two pages of form MC 177S shall be submitted to Depart-
ment of Health Services, Key Data Entry Unit. In addition a copy of form
MC 1 76M shall be submitted with form MC 177S if an adjustment to the
share of cost is being made pursuant to Section 50653.3.
(2) Key Data Entry Unit will cerfify that the share of cost has been met.
(3) The Department will issue Medi-Cal cards to the persons included
in the MFBU.
(d) If the beneficiary signs a Certification of Medical Need/Request
for Medi-Cal Card, MC 113, which indicates a need for inedical services
prior to norinal anticipated receipt of a Department issued Medi-Cal
card, the county department shall:
(1) Enter the date of certification for claims clearance on form MC
177S.
Page 377
Register 2000, No. 38; 9-22-2000
§ 50659
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
(2) Issue a Medi-Cal card to each person who has been listed on form
MC 1 13 as having an immediate need. Card issuance procedures speci-
fied in Article 14 shall be followed.
(3) Indicate on form MC 177S and form MC 176M, if required, the
persons who have been issued a card.
(4) Forward form MC 177S and form MC 176M, if required, to the
Key Data Entry Unit.
NOTE: Authority cited: Sections 10725, 14005.9(c) and 14124.5, Welfare and In-
stitutions Code: Section 1 33.5, AB 25 1 . Chapter 1 02, Statutes of 1 98 1 . Reference:
Sections 14005.4, 14005.7, 14005.9 and 14017, Welfare and Institutions Code.
History
1. Amendment of Subsection (a)(3) and new subsection (a)(8) filed 1 1-30-81 as
an emergency; effective upon filing (Register 8 1 , No. 49). A Certificate of Com-
pliance must be transmitted to OAL within 120 days or emergency language
will be repealed on 3-30-82.
2. Certificate of Compliance filed 3-30-82 (Register 82, No. 14).
3. Amendment of subsection (a)(3) filed 10-1-82 as an emergency; effective upon
filing (Register 82, No. 40). A Certificate of Compliance must be transmined
to OAL within 120 days or emergency language will be repealed on 1-29-83.
4. Certificate of Compliance transmitted to OAL 12-30-82 and filed 2-2-83
(Register 83, No. 6).
5. Editorial correction of NOTE filed 4-12-83 (Register 83, No. 1 6).
6. Amendment filed 7-3-86; effective thirtieth day thereafter (Register 86, No.
27).
§ 50659. Long-Term Care Patients with a Share of Cost.
(a) Form MC 177S shall not be required for a person or family with a
share of cost when all the following conditions are met:
(1) One or more members of the MFBU are LTC patients.
(2) The share of cost is less than or equal to the monthly cost of care
at the Medi-Cal reimbursement rate for the long-term care facility.
(b) If the conditions listed in (a) are met:
(1) All members of the MFBU who are not LTC patients shall be is-
sued Medi-Cal cards with no share of cost listed.
(2) The LTC patient shall be issued a Medi-Cal card that shows the
share of cost.
(3) If there is more than one LTC patient in the MFBU, the MFBU
share of cost shall be divided equally among the LTC patients.
(c) If an MFBU includes LTC patients and the share of cost is in excess
of the cost of care at the Medi-Cal rate, the MFBU shall meet its share
of cost by using form MC 177S procedures described in this article.
NOTE: Article cited: Sections 10725 and 14124.5, Welfare and Institutions Code.
Reference: Sections 14005.4, 14005.7, 14005.9 and 14006, Welfare and Institu-
tions Code.
History
Amendment of subsection (a) and new subsection (d) filed 8-8-80 (Register 80,
No. 32).
2. Amendment filed 7-3-86; effective thirtieth day thereafter (Register 86, No.
27).
§ 50660. MFBUs Which Include a Title II Disregard Person.
(a) Form MC 177S shall not be required for an aged, blind or disabled
person who meets the conditions specified in Section 50564. Each Title
II disregard person shall be issued a Medi-Cal card with no share of cost.
(b) The remaining MFBU members with a share of cost shall have their
case processed in accordance with Section 50655. Those services re-
ceived by the aged, blind or disabled MN person meeting the conditions
of Section 50564 shall not be used to meet the remaining MFBU mem-
bers' share of cost.
(c) A person meeting the conditions of Section 50564 shall be identi-
fied in the case file by the notation "Title II Disregard Person" beside the
person's name on the applicable MC 176.
NOTE: Authority cited: Secfion 14124.5, Welfare and Institudons Code. Refer-
ence; Sections 14005.4 and 14005.7, Welfare and Institutions Code.
History
1. New secfion filed 1-5-78 as an emergency; effective upon filing (Register 78,
No. 1).
2. Certificate of Compliance filed 5-5-78 (Register 78, No. 18).
3. New subsection (d) filed 6-30-78 as an emergency; effecfive upon filing (Reg-
ister 78, No. 26).
4. Editorial correction deleting subsecfion (d) filed 6-10-83 (Register 83, No. 24).
Article 13. Period of Eligibility
§ 50701 . Beginning Date of Eligibility.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Insfitutions
Code. Reference: Secuons 11014, 11016, 14005, 14018 and 14053, Welfare and
Insfitutions Code.
History
1. Amendment of subsecfions (a) and (b)(2) filed 8-7-78; effecfive thirtieth day
thereafter (Register 78. No. 32).
2. Amendment of subsections (a) and (b) filed 7-31-81 as an emergency; effecfive
upon filing (Register 81, No. 33). A Certificate of Compliance must be trans-
mitted to OAL within 120 days or emergency language will be repealed on
11-28-81.
3. Certificate of Compliance transmitted to OAL 11-6-81 and filed 1-27-82
(Register 82, No. 5).
4. Amendment of subsecfion (d) filed 4-1-83; effecfive thirtieth day thereafter
(Register 83, No. 14).
5. Amendment filed 6-3-87; operative 7-3-87 (Register 87, No. 24).
6. Change without regulatory effect repealing article 1 3 and renumbering former
secfion 50701 to new secfion 50193 filed 9-19-2000 pursuant to section 100,
title 1, California Code of Regulations (Register 2000, No. 38).
§ 50703. Period of Eligibility.
NOTE: Authonty cited: Sections 10725 and 14124.5, Welfare and Insfitufions
Code. Reference: Sections 11014, 11016 and 14053, Welfare and Insfitufions
Code.
History
1. Amendment of subsecfion (a) filed 8-7-78; effective thirtieth day thereafter
(Register 78, No. 32).
2. Amendment of subsecfion (d) filed 10-31-78 as an emergency; designated ef-
fective 11-1-78 (Register 78, No. 44).
3. Certificate of Compliance filed 2-6-79 (Register 79, No. 6).
4. Amendment of subsecfion (f) filed 5-30-80 as an emergency; effective upon
filing (Register 80, No. 22). A Certificate of Compliance must be transmitted
to OAH within 120 days or emergency language will be repealed on 9-27-80.
5. Certificate of Compliance filed 9-26-80 (Register 80, No. 39).
6. Amendment of subsection (a) filed 7-31-81 as an emergency; effecfive upon
filing (Register 81, No. 31). A Certificate of Compliance must be transmitted
to OAL within 120 days or emergency language will be repealed on 1 1-28-81 .
7. Certificate of Compliance transmitted to OAL 11-6-81 and filed 1-27-82
(Register 82, No. 5).
8. Amendment of subsecfion (c) filed 12-31-82 as an emergency; effecfive upon
filing (Register 83, No. 2). A Certificate of Compliance must be transmitted to
OAL within 120 days or emergency language will be repealed on 4-30-83.
9. Amendment of subsecfion (e) filed 4-1-83; effective thirtieth day thereafter
(Register 83, No. 14).
10. Certificate of Compliance as to 12-31-82 order transmitted to OAL 4-13-83
and filed 5-16-83 (Register 83, No. 21).
1 1 . Change without regulatory effect renumbering secfion 50703 to section 50195
filed 9-19-2000 pursuant to section 100, title 1 , California Code of Regulations
(Register 2000, No. 38).
§ 50710. Retroactive Eligibility.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Insfitutions
Code. Reference: Secfions 14005.4, 14019, 14019.6, 14142 and 14145, Welfare
and Insfitutions Code.
History
1 . Amendment of subsecfion (a)( 1 ) filed 7-1 9-82 ; effective thirtieth day thereafter
(Register 82, No. 30).
2. Repealer of subsection (a)(3)(C) filed 8-18-82 as an emergency; effective upon
filing (Register 82, No. 34). A Certificate of Compliance must be transmitted
to OAL within 120 days or emergency language will be repealed on 12-16-82.
3. Amendment of subsecfion (a)(1) and new subsection (c) filed 9-1-82 as an
emergency; effective upon filing (Register 82, No. 38). A Certificate of Com-
pliance must be transmitted to OAL within 120 days or emergency language
will be repealed on 12-30-82.
4. Amendment of subsecfion (c) filed 10-1-82 as an emergency; effecfive upon
filing (Register 82, No. 40). A Certificate of Compliance must be transmitted
to OAL within 120 days or emergency language will be repealed on 1-29-83.
5. Certificate of Compliance as to 9-1-82 order filed 12-30-82 (Register 83, No.
1).
6. Editorial correction of 12-30-82 Certificate of Compliance filed 1-3-83 (Reg-
ister 83, No. 1).
7. Certificate of Compliance as to 8-18-82 order transmitted to OAL 12-14-82
and filed 1-21-83 (Register 83, No. 5).
8. Certificate of CompUance as to 1 — 82 order transmitted to OAL 1-28-83 and
filed 2-25-83 (Register 83, No. 9).
Page 378
Register 2000, No. 38; 9-22-2000
Title 22
Health Care Services
§ 50735
•
•
9. Amendment of subsection (a)(2) filed 7-9-87; operative 8-8-87 (Resister 87,
No. 30).
10. Change without regulatory effect renumbering section 50710 to section 50197
filed 9-1 9-2000 pursuant to section 100. title 1 , California Code of Regulations
(Register 2000, No. 38).
§ 50715. Certification for Medi-Cal — Completion.
History
1 . Change without regulatory effect renumbering section 507 1 5 to section 501 99
filed 9-1 9-2000 pursuant to section 100, title 1 , California Code of Regulations
(Register 2000, No. 38).
•
Article 14. Medi-Cal Card Use and
Issuance
§ 50731 . Medi-Cal Card Use.
(a) Persons certified for Medi-Cal shall receive a Medi-Cal card or ei-
ther a PHP identification card, or a PCCM plan restricted card and shall
show proof of eligibility for Medi-Cal services by one of the following:
(1 ) Presenting a valid Medi-Cal card to the Medi-Cal provider of their
choice.
(2) Presenting their valid PHP identification card to a provider in the
PHP in which the beneficiary is enrolled. PHP enrollees may obtain their
services under emergency circumstances from non-PHP providers by
presenting their valid PHP identification card to the provider for pur-
poses of billing the PHP. PHP enrollees also may be entitled to a re-
stricted Medi-Cal card if they are enrolled in a noncomprehensive PHP.
(3) Presenting a valid PCCM plan restricted card to a provider in the
PCCM plan in which the beneficiary is enrolled. PCCM plan enrollees
may obtain services under emergency circumstances from nonplan pro-
viders by presenting a valid PCCM plan restricted card to the provider for
purposes of billing the PCCM plan.
(b) Children who are receiving both SSI/SSP and an AFDC/BHI
supplemental payment shall receive a Medi-Cal card under the SSI/SSP
program only.
NOTE: Authority cited: Secdons 10725 and 14124.5, Welfare and Institufions
Code. Reference: Secfions 14017, 14018 and 14088.16, Welfare and Institufions
Code.
History
1. Amendment filed 8-8-80; effecfive thirneth day thereafter (Register 80, No.
32).
2. Amendment of subsection (a) filed 3-9-90 as an emergency; operafive 3-9-90
(Register 90, No. 12). A Certificate of Compliance must be transmitted to OAL
within 120 days or emergency language will be repealed on 7-9-90.
3. Amendment refiled 7-9-90 as an emergency; operafive 7-9-90 (Register 90,
No. 35). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed by operadon of law on 1 1-6-90.
4. Request to readopt amendment on an emergency basis pursuant to Government
Code section 1 1346.1 granted and filed 1 1-6-90 as an emergency; operative
1 1-6-90 (Register 91, No. 6). A Certificate of Compliance must be transmitted
to OAL by 3-^91 or emergency language will be repealed by operadon of law
on the following day.
5. Certificate of Compliance as to 11-6-90 order transmitted to OAL 2-22-91;
disapproved by OAL on 3-25-91 (Register 91, No. 18).
6. Amendment of subsection (a) filed 3-25-91 as an emergency; operative
3-25-91 (Register 91, No. 18). A Certificate of Compliance must be transmitted
to OAL by 7-23-9 1 or emergency language will be repealed by operadon of law
on the following day.
7. Certificate of Compliance as to 3-25-91 orderincludingamendment of subsec-
tion (a)(3) transmitted to OAL 7-19-91 and filed 8-19-91 (Register 92, No. 1).
§ 50732. Medi-Cal— Signature Requirement.
(a) Each Medi-Cal beneficiary must sign and date his/her Medi-Cal
card in the space provided upon receipt and prior to presentation of the
card for any services.
(b) The requirement in (a) above shall not apply to the following:
(1) Medi-Cal beneficiaries who are under 18 years of age.
(2) Medi-Cal beneficiaries who are in Long Term Care as defined in
Section 50056.
(c) For purposes of subsection (a), for persons who are unable to sign
their name or make a mark in lieu of a signature, "sign" shall mean a de-
termination by the provider of services that the individual is unable to
sign the Medi-Cal card because of a disability.
NOTE: Authority cited: Section 14124.5 Welfare and Insdtutions Code. Refer-
ence: secdon 14018, Welfare and Institutions Code.
History
1 . New section filed 1-3-86 as an emergency; effective upon filing (Register 86.
No. 1).
2. Order of Repeal of 1-3-86 emergency order filed 1-3-86 by OAL pursuant to
Government Code Section 1 1349.6 (Register 86, No. 1).
3. New secdon filed 1-28-86 as an emergency; effective upon filing (Register 86,
No. 5). A Certificate of Compliance must be tjansmitted to OAL within 120
days or emergency language will be repealed on 5-28-86.
4. Certificate of Compliance including amendment transmitted to OAL 5-16-86
and filed 6-5-86 (Register 86, No.^23).
§ 50733. Medi-Cal Card — Authorization for Services.
(a) The Medi-Cal card shall be authorization for the person named on
the card to receive those Medi-Cal covered services for which the person
is eligible.
(b) The Medi-Cal card shall be authorization for payment of claims
only for the cost of Medi-Cal covered services which are all of the fol-
lowing:
(1) Incurred during the month in which the Medi-Cal card is valid.
(2) Not paid or obligated by the beneficiary to meet the share of cost
requirement.
(3) Not provided by the PHP or PCCM plan of which the beneficiary
is a member.
(4) Not payable by a third party under a contractual or other legal en-
titlement.
(5) Not prohibited due to the limited service status of the beneficiary.
(c) A mother's Medi-Cal card shall be authorization for services for
her newborn child, if the conditions of (b) are met, during the month of
birth and the month following the month of birth.
(d) It shall be a misdemeanor for a beneficiary to sell, furnish, give or
lend the beneficiary's Medi-Cal card to any other person or persons for
their use.
NOTE: Authority cited: Sections 10725, 14124.5 and 14312, Welfare and Insdtu-
tions Code. Reference: Sections 14010, 14017, 14018 and 14088.16, Welfare and
Institudons Code.
History
1. Amendment of subsecdon (d) filed 12-15-77; effective thirtieth day thereafter
(Register77, No. 51).
2. Amendment of subsecdons (a), (b) and (d) filed 8-8-80; effecfive thirtieth day
thereafter (Register 80, No. 32).
3. Amendment of subsection (b)(3) filed 3-9-90 as an emergency; operative
3-9-90 (Register 90, No. 1 2). A Certificate of Compliance must be transmitted
to OAL within 120 days or emergency language will be repealed on 7-9-90.
4. Amendment refiled 7-9-90 as an emergency; operadve 7-9-90 (Register 90,
No. 35). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed by operation of law on 1 1-6-90.
5. Request to readopt amendment on an emergency basis pursuant to Government
Code section 1 1346.1 granted and filed 1 1-6-90 as an emergency; operative
1 1-6-90 (Register 91, No. 6). A Certificate of Compliance must be transmitted
to OAL by 3-6-91 oremergency language will be repealed by operadon of law
on the following day.
6. Certificate of Compliance as to 11-6-90 order transmitted to OAL 2-22-91;
disapproved by OAL on 3-25-91 (Register 91, No. 18).
7. Amendment of subsection (b) filed 3-25-91 as an emergency; operative
3-25-91 (Register 91 , No. 1 8). A Certificate of Compliance must be transmitted
to OAL by 7-23-91 or emergency language will be repealed by operadon of law
on the following day.
8. Certificate of Compliance as to 3-25-91 order transmitted to OAL 7-19-91 and
filed 8-19-91 (Register 92, No. 1).
§ 50735. Locations at Which Medi-Cal Card May Be Used.
(a) The Medi-Cal card shall be authorization for payment for Medi-
Cal covered services received in any California county.
(b) The Medi-Cal card shall be authorization for payment for Medi-
Cal covered services provided outside California in accordance with Sec-
tion 51006.
Page 379
Register 2000, No. 38; 9-22-2000
§ 50737 BARCLAYS CALIFORNIA CODE OF REGULATIONS Title 22
§ 50737. Format of Medi-Cal Card. (2) The date of certification for claims clearance.
(a) A Medi-Cal card issued by the Department or by the county depart- (d) The Medi-Cal card for persons in long-term care, with a share of
ment in accordance with these regulations shall be used to authorize ser- cost less than or equal to the monthly cost of care at the Medi-Cal reim-
vices. bursement rate for the long-term care facility, shall contain:
(b) The Medi-Cal card for persons with no share of cost shall contain: (1) The items listed in (b).
(1 ) Complete and accurate information identifying the beneficiary, the (2) The amount of the share of cost.
program under which eligibility has been established and other health NOTE; Authority cited: Sections 10725, 14005.9(c), 14124.5 and 14312, Welfare
care coverage entitlement and Institutions Code; Section 133.5, AB 251, Chapter 102, Statutes of 1981. Ref-
/-.x A7 i-j . J J u . •. • . »* J- -^ 1 erence: Sections 14005.9, 14010 and 14017, Welfare and Institutions Code.
(2) Valid month and year and whether it is a past month Medi-Cal History
^^^^- 1 . Amendment filed 8-8-80; effective thirtieth day thereafter (Register 80, No.
(3) Information on limited service or PHP status, if apphcable. 32).
(4) Two MEDl labels, if the card is a full complement card. 2. Amendment of subsection (c) filed 1 1-30-81 as an emergency; effective upon
(5) Proof of eligibility (POE) labels. f"'"? (Register 81 , No. 49). A Certificate of Compliance must be transmitted
/ \ T-u A* J- /^ 1 J 4.- u u . »i- • u r ^ to OAL within 120 days or emergency laneuage will be repealed on 3-30-82.
(c) The Medi-Cal card tor persons who have met their share of cost ,. ^, , .5 ^^ „^ " n^., ,.
, ... w / A4/- mc un • 3.CertificateofCoiTipliancefiled3-30-82(Register82, No. 14).
and are required to complete form MC 177S, shall contain:
(1) The items listed in (b).
Page 380 Register 2000, No. 38; 9-22-2000
Title 22
Health Care Services
§ 50743
•
•
4. Amendment of subsection (c) filed 10-1-82 as an emergency; effective upon
filing (Register 82, No. 40). A Certificate of Compliance must be transmitted
to OAL within 120 days or emergency language will be repealed on 1-29-83.
5. Certificate of Compliance transmitted to OAL 12-30-82 and filed 2-2-83
(Register 83, No. 6).
§ 50739. Full Complement and POE Only Medi-Cal Cards.
(a) A full complement Medi-Cal card is one which has POE labels and
two MEDI labels. This type of Medi-Cal card shall be issued to a benefi-
ciary who is not enrolled in a PHP:
(J) As the initial card for the curfent month of certification for Medi-
Cal.
(2) As the initial card for any month of a retroactive period during
which there is certification for Medi-Cal.
(3) As a replacement card for a person who is entitled to and has re-
quested a card, has completed a Request for Medi-Cal Card or Addition-
al POE Labels, form MC 110, and has not received a card.
(4) As a replacement card if the original was incorrect or mutilated and
was returned to the county department with both MEDI labels intact.
(b) A Medi-Cal card with POE labels only shall be issued:
(1) To replace a lost or stolen card or a inutilated card with the MEDI
labels missing.
(2) When additional POE labels are requested.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14017, Welfare and Institutions Code.
History
1. Amendment of subsections (a)(4) and (b)(1) filed 12-17-77; effective thirtieth
day thereafter (Register 77, No. 51).
2. Amendment filed 8-8-80; effecfive thirtieth day thereafter (Register 80, No.
32).
§ 50740. Medi-Cal Cards for Restricted Medi-Cal Benefits
to Certain Aliens.
An alien who is eligible for restricted Medi-Cal benefits, and who
meets all other eligibility requirements, shall receive a Medi-Cal card
which entitles him or her to program-covered services to treat an emer-
gency medical condition as defined in section 14007.5(d) of the Welfare
and Institutions Code and section 440.255 of tide 42 of the Code of Fed-
eral Regulations, and pregnancy-related services, as defined in section
1(g) of chapter 1441 of the Statutes of 1988, and section 440.255 of title
42 of the Code of Federal Regulations.
NOTE; Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code; and Section 9, Chapter 1441, Statutes of 1988. Reference: Section 14007.5,
Welfare and Institutions Code.
History
1. New section filed 1 1-14-89 as an emergency pursuant to section 9 of chapter
1441 of the Statutes of 1988; operative 11-14-89 (Register 89, No. 48). A Cer-
tificate of Compliance must be transmitted to OAL within 120 days or emergen-
cy language will be repealed on 3-14-90.
2. New section refiled 3-8-90 as an emergency pursuant to section 9 of chapter
1441 ofthe Statutes of 1988; operafive 3-1 3-90 (Register 90, No. 12). A Certifi-
cate of Compliance must be transmitted to OAL within 120 days or emergency
language will be repealed on 7-1 1-90.
3. Certificate of Compliance as to 3-8-90 order transmitted to OAL 7-5-90 and
disapproved 8-6-90 (Register 90, No. 42).
4. New section filed 8-23-90 as an emergency pursuant to section 9 of chapter
1441 of the Statutes of 1988; operafive 8-23-90 (Register 90, No. 42). A Certifi-
cate of Compliance must be transmitted to OAL by 1 2-2 1 -90 or emergency lan-
guage will be repealed by operation of law on the following day.
5. Certificate of Compliance including amendment as to 8-23-90 order trans-
mitted to OAL 1 1-20-90 and filed 12-17-90 (Register 91, No. 5).
§ 50741 . Medi-Cal Card Issuance by the Department.
(a) The Department shall issue a Medi-Cal card to each person who
is not enrolled in a comprehensive PHP and is any of the following:
(1) Reported by the county department as both eligible and certified
for Medi-Cal and for whom the county department is requesting that a
card be issued.
(2) Reported by the Social Security Administration as eligible for SSI/
SSR
(3) Certified for Medi-Cal by BRU.
Note: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Secfion 14017, Welfare and Institutions Code.
History
1. Amendment filed 3-5-81; effective thirtieth day thereafter (Register 81, No.
10).
§ 50742. Limitations on Eligibility Reports and Card
Issuance Requests Submitted by the County
Department.
(a) The county department shall not submit a report of ehgibility to the
Department for a person for a given month, or request the Department to
issue a Medi-Cal card for a person for a given month, as long as any one
of the following applies to that person for that month:
(1) The county has information which requires discontinuance of the
person for that month.
(2) The person is subject to discontinuance for the month due to loss
of contact or noncooperation.
(b) The county department shall not request the Department to issue
a Medi-Cal card for a person for a month during the following periods:
(1) From time of county receipt of information which requires that the
person be assigned a share of cost and receive a form MC 177S for a
month, until the completed MC 177S is submitted to the county depart-
ment.
(2) From dme of county receipt of information which requires that an
LTC person receive an increased share of cost, until determination of the
increased share of cost is made.
(c) The county department shall not withhold a report of eligibility for
the beneficiary for the coming month if information requiring an adverse
action is received too late in a month for the county department to make
that action effective the coming month because timely notice of the ad-
verse action cannot be provided to the beneficiary.
(d) This section applies to all Medi-Cal eligibles including public as-
sistance recipients.
(e) The report of eligibility data required by this section shall be com-
pleted in accordance with schedules issued by the Director.
NOTE: Authority cited: Sections 10554.1 and 14124.5, Welfare and Institutions
Code. Reference: Sections 10600, 10850, 11004, 11050, 11051, 11052, 11054,
11055, 12305, 14000.2, 14001. 14005, 14005.1, 14005.4, 14005.7, 14011, 14012,
14014, 14016, 14050.1, 14051 and 14052, Welfare and InstituUons Code.
History
1. New section filed 9-1-78; effective thirtieth day thereafter (Register 78, No.
35).
§ 50743. Medl-Cal Card Issuance by the County
Department — No Share of Cost.
(a) The county department shall issue a current or past month Medi-
Cal card as limited by Section 50746, to each person who meets all of the
following conditions:
(1) Is eligible for SSI/SSP. The county department shall verify SSI/
SSP eligibility by obtaining information from the SDX data available to
the county. If the SDX data on the individual does not appear to be accu-
rate or complete, proof of eligibility shall be any of the following:
(A) The SSI/SSP check for the month for which the card is requested.
(B) Documentation from the Social Security Administration verifying
eligibility.
(C) An SSI/SSP award letter received that month.
(D) An approved Title XVI emergency loan for that month.
(E) Other proof of eligibility as specified by the Department.
(2) Is not enrolled in a comprehensive PHP for the month for which
a card is requested.
(3) Needs any of the following:
(A) Additional or duplicate POE labels.
(B) A replacement for a mutilated card.
(C) A replacement for a card containing erroneous data.
(D) A replacement Medi-Cal card because the original card was not
received. In this case, the SSI/SSP recipient shall complete and sign form
MCllO.
Page 381
Register 92, No. 1; 1 -3-92
§ 50745
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
(b) The county departmenl may issue current or past month Medi-Cal
cards, as limited by Section 50746, to all other Medi-Cal eligibles who
meet all of the following conditions:
(J) Do not have a share of cost.
(2) Are not enrolled in a comprehensive PHP for the month for which
a card is requested.
(3) Did not receive a Medi-Cal card. In this case, the beneficiary shall
complete and sign form MC 110.
NOTE: Authority cited: Sections 10723 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14017.8 and 141 15, Welfare and Institutions Code.
History
1 . Amendment filed 12-15-77; effective thirtieth day thereafter (Register 77, No.
51).
2. Amendment filed 3-5-81; effective thirtieth day thereafter (Register 81, No.
10).
3. Amendment of subsection (a) filed 7-9-87; operative 8-8-87 (Register 87, No.
30).
§ 50745. Medi-Cal Card Issuance by the County
Department — Share of Cost.
(a) The county department may issue current or past month Medi-Cal
cards, as limited by Section 50746, to persons who are in long-term care
and have a share of cost which is less than or equal to the monthly cost
of care at the Medi-Cal reimbursement rate for the long-term care facil-
ity unless the person in long-term care also has a spenddown of property.
(b) The county department shall issue current month Medi-Cal cards
with MEDI or POE labels to persons with a share of cost met by use of
form MC 1 77S, if the person who requests the card signs a form MC 110
which indicates a need for medical services prior to normal anticipated
receipt of a Department issued Medi-Cal card. In this case the county de-
partment shall process form MC 177S in accordance with Section 50658.
(c) The county department may issue current or past month Medi-Cal
cards with POE labels only, as limited by Section 50746, to persons with
a share of cost if certification by the county department or BRU has oc-
curred.
(d) The Director may order the suspension of county issuance of
Medi-Cal cards for persons with a share of cost, if the Director deter-
mines that the cost of the procedure is exceeding allowable costs under
the Department's program for control of county department Medi-Cal
administrative costs.
(1) The Director shall inform a county department of the suspension
in that county, in writing, 30 days prior to the effective date of the suspen-
sion.
(2) The Director may reinstate the county issuance of Medi-Cal cards
for persons with a share of cost, if it is determined that sufficient funds
are available. Notification of the reinstatement shall be in writing.
§ 50746. Limitation on Medi-Cal Card Issuance.
(a) The county department shall not provide a Medi-Cal card or re-
quest that a Medi-Cal card be issued by the Department to any Medi-Cal
beneficiary more than one year subsequent to the month of service, un-
less one of the following conditions is met:
(1) A court action requires that a Medi-Cal card be issued.
(2) An adopted State hearing decision or other administrative hearing
decision requires a redetermination of eligibility which results in a bene-
ficiary's entidement to a Medi-Cal card.
(3) An adopted State hearing decision states that, due to a county de-
partment or Department administrative error, a Medi-Cal card for a
month was not received by the beneficiary.
(4) The Department requests that the Medi-Cal card be issued.
(5) The county department has determined that an administrative error
has occurred.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14017 and 14115, Welfare and InsUtutions Code.
History
1. Amendment of subsection (a) filed 5-30-80 as an emergency; effective upon
filing (Register 80, No. 22). A Certificate of Compliance must be transmitted
to OAH within 120 days or emergency language will be repealed on 9-27-80.
2. Certificate of Comphance filed 9-26-80 (Register 80, No. .39).
3. Repealer ofsubsection(b) filed 7-9-87; operative 8-8-87 (Register 87, No. 30).
§ 50749. Control of County Issued Medi-Cal Cards.
(a) The county department shall record every Medi-Cal card issued or
voided by the county department on the Control Log for MC 301, form
HAS 2007.
(b) The county department may, with Department approval, use a sub-
stitute for form HAS 2007.
(c) The county department shall account for stocks of Medi-Cal cards,
as required by the Department.
NOTE: Authority cited: Sections 10725 and 14124.5. Welfare and Institutions
Code. Reference: Section 14017, Welfare and Institufions Code.
History
1 . Amendment filed 8-8-80; effective thirtieth day thereafter (Resiscer 80, No.
32).
§ 50751 . Report of Eligibles.
(a) The Department shall compile a monthly report of all persons eligi-
ble for Medi-Cal. This Report of Eligibles shall include all persons:
(1) Certified for Medi-Cal by the county department and reported to
the Department for issuance of Medi-Cal cards or listing as enrolled in
a PHP or PCCM plan.
(2) Certified for Medi-Cal and issued Medi-Cal cards by the county
department.
(3) With a share of cost. These persons are reported as eligible but not
certified for Medi-Cal.
(4) Certified for Medi-Cal and issued Medi-Cal cards by Benefits Re-
view Unit.
(5) Reported by the Social Security Administration as eligible.
(b) The county department shall report the information specified in
(a)(1), (2) and (3) in accordance with Department procedures.
NOTE: Authority cited: Secdons 10725, 14105 and 14124.5, Welfare and Institu-
tions Code. Reference: Sections 14017.8 and 14088.16, Welfare and Institutions
Code.
History
1. Amendment of subsecfion (a)(1) filed 3-9-90 as an emergency; operative
3-9-90 (Register 90, No. 12). A Certificate of Compliance must be transmitted
to OAL within 120 days or emergency language will be repealed on 7-9-90.
2. Amendment refiled 7-9-90 as an emergency; operative 7-9-90 (Register 90,
No. 35). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed by operation of law on 1 1-6-90.
3. Request to readopt amendment on an emergency basis pursuant to Government
Code section 11346.1 granted and filed 11-6-90 as an emergency; operative
1 1-6-90 (Register 91 , No. 6). A Certificate of Compliance must be transmitted
to OAL by 3-6-9 1 or emergency language will be repealed by operation of law
on the following day.
4. Certificate of Comphance as to 1 1-6-90 order transmitted to OAL 2-22-91 ;
disapproved by OAL on 3-25-91 (Register 91, No. 18).
5. Amendment of subsection (a) filed 3-25-91 as an emergency; operafive
3-25-91 (Register 91, No. 18). A Certificate of Compliance must be transmitted
to OAL by 7-23-91 or emergency language will be repealed by operation of law
on the following day.
6. Certificate of Compliance as to 3-25-91 order transmitted to OAL 7-19-91 and
filed 8-19-91 (Register 92, No, 1).
Article 15. Other Health Care Coverage and
Medicare Buy-In Coverage
§ 50761 . Other Health Care Coverage — General.
A beneficiary with other health care coverage is not entitled to receive
health care benefits and services under the Medi-Cal schedule of benefits
until the other health care coverage available has been exhausted or de-
nied for lack of service coverage. This requirement shall not, however,
apply to beneficiaries covered under Medi-Cal capitated contracting ar-
rangements except to the extent permitted under a contract.
NOTE: Authority cited: Section 10725 and 14124.5, Welfare and Institufions
Code. Reference: Secfions 10020, 14000, 14023, 14023.7 and 14490, Welfare and
Insfitutions Code.
Page 382
Register 92, No. 1; 1-3-92
Title 22
Health Care Services
§ 50771.5
•
History
1 . Repealer and new section filed 6-28-89; operative 7-28-89 (Reeister 89, No.
26).
§ 50763. Beneficiary Responsibility— Other Health Care
Coverage.
(a) An applicant or beneficiary shall:
(1) Apply for, and/or retain any available health care coverage when
no cost is involved.
(2) Report to the county department any entitlement to other health
care coverage at the time of application, reapplication, or redetermina-
tion; and report any change in entitlement no later than 10 calendar days
from the date the beneficiary was notified of the change by the employer
or insurer. The report shall include name of carrier, policy and group
numbers, and termination date, if available.
(3) Utilize other available health care coverage prior to utilizing Medi-
Cal coverage.
(4) Report to the county department services received as the result of
an accident or injury as specified in Section 50771 (b), and report the in-
formation specified in Section 50771(d)(2).
(5) Provide current other health care coverage billing information to
the provider at the time the service is received. This information shall in-
clude the name of the other health care coverage, policy and group num-
bers, and termination date, if available.
(b) Compliance with the other health care coverage requirements of
subsection (a)(1) shall be a condition of receiving Medi-Cal covered
benefits to the party responsible for the acquisition or continuance of
such health care coverage, and shall not interfere with Medi-Cal benefits
provided to the remaining family unit..
HrSTORY
1. Amendment filed 6-28-89; operative 7-28-89 (Register 89, No. 26)
§ 50765. County Department Responsibility— Other Health
Care Coverage.
(a) The county department shall:
(1) Determine the other health care coverage in effect or available to
an applicant or beneficiary upon each determination or redetermination
of Medi-Cal.
(2) Code the other health care coverage using the coding system pre-
scribed by the Department.
(3) Provide information regarding the beneficiary's other health care
coverage to the Department in the manner, form and frequency re-
quested.
(4) Notify the Department that the beneficiary's other health care cov-
erage has lapsed or will lapse no later than five working day's following
the receipt of such information.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference Sections 141 24.90 and 14124.91, Welfare and Institutions Code.
History
1 . Amendment filed 6-28-89; operative 7-28-89 (Register 89, No. 26).
§ 50769. Department Responsibility — Other Health Care
Coverage.
(a) On the Medi-Cal card of beneficiaries who have other health care
coverage, the Department shall place an indicator code to give notice to
providers and beneficiaries that other health care coverage must be uti-
lized prior to billing the Medi-Cal program.
(b) The Department's fiscal intermediary shall, as directed by the De-
partment, deny provider claims submitted for beneficiaries who have
other health care coverage unless the claim is accomplished by a notice
of denial of non-coverage of service, termination of coverage, or partial
payment which is less than the Medi-Cal schedule of benefits for the ser-
vice or benefit provided. A provider of service may submit a copy of the
original notice of denial or explanation of benefits letter from the other
health care coverage. This notice or letter is valid for a period of one year
from the date the service was denied. The notice or letter must be accom-
panied by a completed Medi-Cal claim form for the same service pro-
vided to the beneficiary as indicated on the notice or letter.
(c) When Medi-Cal payment has been made before the other health
care coverage has been identified, the Department shall recover pay-
ments from the parties having a legal obligation.
NOTE; Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code, Reference: Sections 14023, 14023.7, 14124.90. Welfare and Institutions
Code.
History
1. Repealer and new section filed 6-28-89: operative 7-28-89 (Register 89, No.
28).
§ 50771 . Recovery of Third Party Payments.
(a) A beneficiary shall reimburse the Department for any payment re-
ceived for health care services which were paid by Medi-Cal, if the pay-
ment received by the beneficiary is made by either of the following:
(1) A federal or state program.
(2) A legal or contractual entitlement.
(b) A beneficiary who receives health care services as a result of an ac-
cident or injury caused by some other person's action or failure to act
shall furnish the Department with an assignment of rights to receive pay-
ment for those services, if those services will be billed to Medi-Cal. If
the beneficiary is unable to make the assignment, the beneficiary's
guardian, attorney or the person acting on the beneficiary's behalf shall
do so.
(c) The Department may file a hen against the property of a beneficiary
if the beneficiary fails to comply with the requirement in (b).
(d) The county department shall provide the following written infor-
mation to the Department of Benefit Payments concerning a beneficiary
who may meet the conditions of (b).
(1) The name and address of the beneficiary.
(2) The name and address of the:
(A) Attorney handling the case.
(B) Insurance carriers responsible for payment.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institufions
Code; and Section 87, Chapter 1594, Statutes of 1982. Reference: Section 14006,
Welfare and Institutions Code.
History
1. Amendment of subsection (c) filed 12-31-83 as an emergency; effective upon
filing (Register 83, No. 2). A Certificate of Compliance must be transmitted to
OAL within 120 days or emergency language will be repealed on 4-30-83.
2. Certificate of Compliance transmitted to OAL 4-29-83 and filed 6-3-83 (Reg-
ister 83, No. 23).
§ 50771 .5. Determination of Good Cause for Refusal to
Cooperate.
(a) Good cause exists when cooperation is against the best interest, as
specified in (b) and (c) below, of an applicant, beneficiary, or child for
whom application is made or Medi-Cal received. These regulations shall
not preclude the county welfare department from contracting with the
district attorney for assistance in the investigation of good cause claims.
(b) Good cause exists if the applicant's or beneficiary's cooperation
in securing medical support and payments, establishing paternity, identi-
fying and providing information concerning liable or potentially liable
third parties is reasonably anticipated to result in serious physical or emo-
tional harm;
(1) To the child for whom support is to be sought;
(2) To the parent or caretaker relative with whom the child is living as
specified in (d) below.
(c) The county believes that proceeding to secure medical support or
establish paternity would be detrimental to the child for whom such sup-
port would be sought because at least one of the following circumstances
exists:
(1) The cliild for whom such support is sought was conceived as a re-
sult of incest or forcible rape;
(2) Legal proceedings for the adoption of the child are pending before
a court of competent jurisdiction; or
(3) The applicant or beneficiary is currently being assisted by a public
or licensed private social service agency to resolve the issue of whether
Page 383
Register 93, No. 39; 9-24-93
§ 50771.5
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
to keep the child or relinquish him/her for adoption, and the discussions
have not gone on for more than three months.
(d) Serious physical or emotional harm as it relates to the parent or
caretaker relative means substantial reduction of the capacity of the par-
ent or caretaker relative to care for the child adequately. The mere belief
of the parent, caretaker relative, applicant, or beneficiary that coopera-
tion could or would result in harm shall not be a sufficient basis for find-
ing good cause.
(e) A finding of good cause for emotional harm shall be based only
upon a demonstration of an emotional impairment that substantially af-
fects the individual's functioning. The county shall consider the follow-
ing when determining emotional harm:
(1) The present emotional state of the individual subject to emotional
harm;
(2) The emotional health history of the individual subject to emotional
harm;
(3) The intensity and probable duration of the emotional impairment;
(4) The degree of cooperation to be required; and
(5) The extent of the involvement of the individual in the paternity es-
tablishment or support enforcement activity to be undertaken.
(f) An applicant, beneficiary, parent, or caretaker relative who claims
to have good cause for refusing to cooperate shall have the burden of
proof in establishing the existence of good cause. The individual shall be
required to:
(1) Specify the circumstances described in (b) above that the individu-
al believes provides sufficient good cause for not cooperating;
(2) Provide sufficient information (such as the putative father or absent
parent's name and address, if known) to permit an investigation pursuant
to (/) below; and
(3) Provide corroborative evidence as described in Section 50771 .5(g)
within 20 days from the day the claim of good cause was made. In excep-
tional cases, where the county determines the individual requires addi-
tional time because of the difficulty of obtaining corroborative evidence,
a reasonable additional period of time shall be allowed upon request of
the individual and approval by county supervisory personnel.
(g) Good cause may be corroborated by:
(1) Birth certificate or medical or law enforcement records which indi-
cate that the child was conceived as the result of incest or forcible rape;
(2) Court documents or other records which indicate that legal pro-
ceedings for adoption are pending before a court of competent jurisdic-
tion;
(3) Court, medical, criminal, child protective services, psychological,
or law enforcement records which indicate that the putative father or ab-
sent parent might inflict physical or emotional harm on the child, parent,
or caretaker relative;
(4) Medical records which indicate emotional health history and the
present emotional health status of the parent, caretaker relative, or the
child for whom support would be sought; or written statements from a
mental health professional indicating a diagnosis or prognosis concern-
ing the emotional health of the parent, caretaker relative, or the child for
whom support would be sought;
(5) A written statement from a public or licensed private social service
agency that the applicant or beneficiary is being assisted by the agency
to resolve the issue of whether to keep the child or relinquish him/her for
adoption;
(6) Statements under penalty of perjury from individuals, other than
the applicant or beneficiary, with actual knowledge of the circumstances
which provide the basis for the good cause claim.
(h) The county shall examine the corroborative evidence supplied by
the applicant, beneficiary, parent, or caretaker relafi ve to ensure that it ac-
tually verifies the good cause claim.
(i) If, after examining the corroborative evidence submitted by the in-
dividual, the county wishes to request additional corroborative evidence
which is needed to justify a determination of good cause, the county shall:
(1) Promptly inform the applicant or beneficiary that additional cor-
roborative evidence is needed; and
(2) Specify the type of evidence which is needed,
(j) Upon request, the county shall:
( 1 ) Advise the apphcant or beneficiary how to obtain the necessary ev-
idence.
(2) Make a reasonable effort to obtain specific information which the
applicant or beneficiary is not reasonably able to obtain without assis-
tance.
(k) Where a claim is based on the individual' s anticipation of physical
harm as defined in (d) above, and corroborative evidence is not submitted
in support of the claim:
(1) The county shall make reasonable efforts to examine, review, and
evaluate the good cause claim when it believes that:
(A) The claim is credible without corroborative evidence; and
(B) Corroborative evidence is not available.
(2) Good cause shall be found if the claimant's statement and the in-
vestigafion which is conducted satisfy the county that the individual has
good cause for refusing to cooperate.
(3) A determinafion that good cause exists shall be reviewed and ap-
proved or disapproved by county supervisory personnel and the county's
findings shall be recorded in the case record.
(/) In the course of determining whether good cause exists, the county
shall not contact the absent parent or putative father from whom support
would be sought unless such contact is determined to be necessary to es-
tabhsh the good cause claim.
(1) Prior to making contact with the absent parent or putafive father,
the county will inform the applicant or beneficiary that the absent parent
or putafive father may be contacted unless the applicant or beneficiary:
(A) Presents additional corroborafive evidence or informaUon so that
contact with the parent or putafive father becomes unnecessary:
(B) Withdraws the applicafion for assistance or requests discontinu-
ance.
(2) The county shall inform the applicant or beneficiary that he/she
may request the good cause claim be denied. If the applicant or beneficia-
ry makes this request, the county shall send the appropriate Notice of Ac-
tion.
(m) Prior to making a final determinafion of good cause for refusing
to cooperate, the county shall:
(1 ) Afford the district attorney the opportunity to review and comment
on the findings and basis for the proposed determination;
(2) Consider any recommendation from the district attorney; and
(3) Give the district attorney the opportunity to participate as a witness
in any hearing (under the Department of Social Services Manual of Poli-
cies and Procedures (DSS-MMP) Chapter 22-000) that results from an
apphcant' s or beneficiary's appeal of any county acfion relafing to estab-
lishing paternity or securing medical support.
(n) The county shall determine whether or not good cause exists, based
on the applicant's or beneficiary's statement, together with the corrobo-
rative evidence, if the statement and evidence provide a sufficient basis
for making a determinafion. The county may further verify the good
cause claim through an investigafion if necessary.
(0) The determinafion of whether or not good cause exists shall be
made within 45 days from the day the good cause claim is made. This
time standard may be exceeded only where the case record documents
that the county needs addifional time because:
(1) The information required to verify the claim cannot reasonably be
obtained within 45 days; or
(2) The applicant or beneficiary did not provide corroborative evi-
dence within the period required by (f)(3).
(p) The applicant or beneficiary shall be nofified on the appropriate
Notice of Acfion form of the final determinafion that good cause does or
does not exist. If good cause does not exist, the nofice shall also specify
that:
Page 384
Register 9'X No. 39; 9-24-93
Title 22
Health Care Services
§ 50775
•
•
(1) The applicant or beneficiary will be afforded an opportunity to
cooperate, to withdraw the application for assistance, or to have the case
closed; and
(2) Continued refusal to cooperate will result in ineligibility for the
applicant or beneficiary who refuses, in accordance with Section 50379;
however, eligibility will be granted for the other members of the MFBU,
if otherwise eligible.
(q) If good cause exists, the county shall determine whether medical
support enforcement may proceed without unreasonable risk of harm to
the child, parent, or caretaker or relative if the caretaker relative does not
participate in these medical support activities.
(1) This determination shall be in writing, shall contain the county's
findings and basis for the determination, and shall be entered into the case
record.
(2) If the county determines that good cause exists and that the district
attorney may proceed to establish paternity and enforce medical support,
the county shall notify the applicant or beneficiary to enable such individ-
ual to withdraw his/her application or to have the record closed.
(3) Prior to making this determination, the county shall afford the dis-
trict attorney an opportunity to review and comment on the findings and
basis for the proposed determination and shall consider any recommen-
dation from the district attorney.
(r) Good cause may be denied if the individual fails to meet his/her re-
sponsibilities as specified in (f) above.
(s) If the district attorney determines that a beneficiary has failed or re-
fused to cooperate within the meaning of Section 50185(a)(9) and
(a)(10), the district attorney will provide the county with a statement
which specifies the circumstances of the beneficiary's failure or refusal.
The county shall take action to terminate Medi-Cal to the beneficiary
only when it has verified on the basis of all available evidence that the
beneficiary failed or refused to cooperate without good cause.
(t) The failure of a foster parent or caretaker relative who is not re-
questing Medi-Cal as part of the child's MFBU, to comply with this re-
quirement shall not affect eligibility for the MFBU members. In foster
care situations, the child's natural parent and the placing agency shall be
asked to cooperate to the extent possible.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare aiid Institutions
Code. Reference: Sections 1 1 477 and 14008.6, Welfare and Institutions Code; and
42 C.F.R. Sections 433.135, 433.136, 433.137, 433.138, 433.145, 433.146,
433.147, 433.148 and 435.604.
History
1. New section filed 4-16-93 as an emergency; operative 4-16-93 (Register 93,
No. 16). A Certificate of Compliance must be transmitted to OAL 8-16-93 or
emergency language will be repealed by operation of law on the following day.
2. Certificate of Compliance as to 4-16-93 order including amendment of NOTE
transmitted to OAL 8-13-93 and filed 9-23-93 (Register 93, No. 39).
§ 50772. Veterans Aid and Attendance Payments.
(a) A Veterans Aid and Attendance payment is a veterans benefit des-
ignated to purchase aid and attendance services, and it shall be consid-
ered a third party payment.
(b) A beneficiary who receives Veterans Aid and Attendance pay-
ments shall be required to utilize this benefit in accordance with the fol-
lowing:
(1) Beneficiaries in LTC shall utilize the Aid and Attendance pay-
ments for LTC services prior to the utilization of Medi-Cal benefits.
Such utihzation shall occur through the share of cost process described
in Article 12, that is, any amounts for Veterans Aid and Attendance pay-
ments shall be added to the share of the cost amount determined in Sec-
tion 50653(a)(2)(F).
(2) Beneficiaries not in LTC shall utilize the Aid and Attendance pay-
ments for the cost of IHSS prior to the appHcation of the income deduc-
tion specified in Section 50551.6.
NOTE; Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Section 14024, Welfare and Institutions Code.
History
1. New section filed 2-16-88 as an emergency; operative 2-16-88 (Register 88,
No. 10). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 6-15-88.
2. Emercency language filed 2-16-88 repealed by operation of Government Code
Section 1 1346.1 (Register 88, No. 27).
3. New section refiled 6-22-88 as an emergency; operative 6-22-88 (Register 88,
No. 27). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 10-20-88.
4. Certificate of Compliance transmitted to OAL 6-20-88 and filed 7-15-88
(RegisterSS, No. 31).
§ 50773. Medicare Buy-in.
(a) Medicare Buy-In is the payment of Medicare Part B premiums by
the Department under the California Medicare Buy-In agreement with
the Social Security Administration for Medi-Cal beneficiaries who are:
(1 ) Eligible under the SSI/SSP, Other PA or MN program on the basis
of age.
(2) Eligible under the SSI/SSP, Other PA or MN program on the basis
of bhndness or disability and also eligible for Medicare Part B in accor-
dance with section 50775(a).
(b) State payment of Part B premiums under the Buy-In provisions
shall become effective the:
(1 ) Second month after the month in which Medi-Cal eligibility is ap-
proved for MN persons who were not ehgible for a federally covered
Medi-Cal program in the month before their first month of MN eligibil-
ity.
(2) First month of eligibihty for PA and Other PA recipients and MN
persons not specified in (1).
(3) The first month after the month of eligibility for qualified Medicare
beneficiaries in accordance with Section 50258.
(4) The first month eligibility is approved for Specified Low-Income
Medicare Beneficiaries in accordance with Section 50258.1.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Institutions
Code. Reference: Secfions 14005.1 and 14050.1, Welfare and Institutions Code;
and Section 1396a(a)(10)(E)(iii), Title 42, United States Code.
History
1 . Amendment of subsecfions (a)(] ) and (a)(2) filed 8-7-78; effective thirtieth day
thereafter (Register 78, No. 32).
2. Amendment of subsecfion (a) filed 7-31-81 as an emergency; effective upon
fifing (Register 81, No. 33). A Certificate of Compliance must be transmitted
to OAL within 120 days or emergency language will be repealed on 11-28-81.
3. Certificate of Compliance transmitted to OAL 11-6-81 and filed 1-27-82
(Register 82, No. 5).
4. Amendment of subsection (b)(1) filed 5-15-90; operative 6-14-90 (Register
90, No. 25).
5. Amendment of subsection (b) filed 8-13-90 as an emergency; operative
8-13-90 (Register 90, No. 40). A Certificate of Compliance must be transmitted
to OAL by 12-1 1-90 or emergency language will be repealed by operation of
law on the following day.
6. Certificate of Compliance transmitted to OAL 12-11-90 and filed 1-9-91
(Register 91, No. 8).
7. New subsecfion (b)(4) and amendment of subsecfion (b)(3) and Note filed
12-21-93; operafive 1-20-94 (Register 93, No. 52).
§ 50775. Medicare Coverage.
(a) Persons eligible for both Medicare Part A (Hospital) and Part B
(Outpatient) benefits under the Social Security Act, Title XVIII, are per-
sons or their spouses who have the required number of quarters of cov-
ered employment, are citizens of the United States or aliens legally pres-
ent in the United States for at least five years, and who meet at least one
of the following:
(1) Are 65 years of age or over.
(2) Are entitled to disability, including blindness, benefits for at least
24 consecutive months under Title II of the Social Security Act, or Rail-
road Retirement program.
(3) Meet the requirements for the receipt of Medicare as a patient with
chronic renal disease.
(b) Persons eligible for only Medicare Part B benefits are persons who
are either citizens of the United States or are aliens legally present in the
United States for at least five years, and are all of the following:
(1) Not eligible for Medicare Part A.
(2) Sixty-five years of age or over.
History
1 . Amendment filed 12-15-77; effecfive thirtieth day thereafter (Register 77, No.
51).
Page 385
Register 95, No. 14; 4-7-95
§ 50777
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
§ 50777. Requirement to Apply for Medicare.
(a) The folJowing Medi-Cal applicants and heneticiaries shall be re-
quired to apply for Medicare Part A:
(1) Any person 64 years and 9 months of age or older.
(2) Persons applying for Medi-Cal on the basis of blindness or disabil-
ity.
(3) Persons who are receiving disability payments under title 11 of the
Social Security Act or Railroad Retirement program unless the county
can obtain verification of receipt of Social Security title II disability pay-
ments in accordance with section 501 67. In these instances Medicare en-
rollment is deemed to be automatic beginning with the 25th month of re-
ceipt of this benefit and application is not required.
(4) Persons receiving dialysis-related health care services.
(b) The following Medi-Cal applicants and beneficiaries shall be re-
quired to apply for Medicare Part B:
(1) Persons who are applying for Medi-Cal on the basis of being aged.
(2) Persons applying for Medi-Cal on the basis of blindness or disabil-
ity unless the county can obtain verification of receipt of Social Security
Title 11 disability payments in accordance with section 5167. In these in-
stances Medicare enrollment is deemed to be automatic beginning with
the 25th month of receipt of this benefit and application is not required.
(3) Persons receiving dialysis-related health care services, unless the
county can obtain verification of receipt of Medicare Part A benefits in
accordance with section 50167. In these instances, Medicare Part B en-
rollment is deemed to be automatic and apphcation is not required.
(c) The persons specified in (a) and (b) shall submit verification to the
county department of the approval or denial of their Medicare eligibility
within 60 days of the date they are notified of the requirement to apply
or within 1 days of the notification of approval or denial if their eligibil-
ity for Medicare is not determined within 60 days. Except for those per-
sons applying under Sections 50258 and 50256, persons who would only
be eligible for Medicare Part A if they paid a premium shall not be re-
quired to accept Part A benefits.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005, 14005.3, 14005.11 and 14109. Welfare and In-
stitutions Code; Sections 426(b), 426-1, 1396a(a), 1396d(p), 1396d(s) and
9902(2), Title 42, United States Code; and Sections 4-7. 18(b)(2),
405.210(b)(l)(iv), 408.5, 408.12, 408.13 and 435.603, Title 42, Code of Federal
Regulations.
History
1. Amendment of subsection (a)(4) and repealer of subsection (a)(5) filed 5-16-80
as an emergency; effective upon filing (Register 80, No. 20). A Certificate of
Compliance must be transmitted to OAL within 120 days or emergency lan-
guage will be repealed on 9-14-80.
2. Certificate of Compliance filed 8-22-80 (Register 80, No. 34).
3. Amendment filed 7-5-88; operative 8-4-88 (Register 88, No. 31).
4. Amendment of subsection (c) filed 8-13-90 as an emergency; operative
8-13-90 (Register 90, No. 40). A Certificate ofCompliance must be transmitted
to OAL by 12-1 1-90 or emergency language will be repealed by operation of
law on the following day.
5. Certificate of Compliance transmitted to OAL 12-11-90 and filed 1-9-91
(Register 91, No. 8).
6. Amendment of subsection (c) and Note filed 10-3-94 as an emergency; opera-
tive 10-3-94 (Register 94, No. 40). A Certificate ofCompliance must be trans-
mitted to OAL by 1-31-95 or emergency language will be repealed by opera-
tion of law on the following day.
7. Editorial correction of History Note 6 (Register 95, No. 9).
8. Reinstatement of subsection (c) and Note as they existed prior to emergency
amendment filed 3-2-95 by operation of Government Code section 1 1346,1 (f)
(Register 95, No. 9).
9. Amendment of subsection (c) and Note lefiled 3-3-95 as an emergency; opera-
tive 3-3-95 (Register 95, No. 9). A Certificate ofCompliance must be trans-
mitted to OAL by 7-1-95 or emergency language will be repealed by operation
of law on the following day.
10. Certificate ofCompliance as to 3-3-95 order including amendment of subsec-
tion (c) transmitted to OAL 2-22-95 and filed 4-5-95 (Register 95, No. 14).
§ 50778. Other Healtli Care Coverage Premium Payment,
(a) The Department in accordance with the period of eligibility as stip-
ulated within the policyholder's contract, or in accordance with the peri-
od of eligibility as stipulated for continuation of coverage under federal
law, shall pay the premiums to provide other health care coverage for a
beneficiary with entitlement to such coverage when the annual cost of the
premium is less than half the estimated cost of Medi-Cal benefits. The
estimated cost of Medical benefits shall be determined by the Depart-
ment by the review of either:
(1) Costs of covered medical services received by the beneficiary dur-
ing the preceding year, irrespective of the payment source; or
(2) Estimated annual cost of medical services for the treatment of the
beneficiary's pre-existing medical condition.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Secfion 14124.91, Welfare and Institutions Code: and 42 USC
l396b(A)(l).
History
1. New section filed 6-28-89; operative 7-28-89 (Register 89, No. 26).
Article 16. Overpayments, Fraud and
Improper Utilization
§ 50781 . Potential Overpayments.
(a) A potential overpayment occurs when all of the following condi-
tions exist, as limited by (b).
(1) A beneficiary, or other person acting on the beneficiary's behalf,
has been informed verbally and in writing on the MC 210 cover sheet
(9/91), and the certification in the Statement of Facts (Medi-Cal), MC
210 (3/92), or on the cover sheet to and the Application for Cash Aid,
Food Stamps, and/or Medical Assistance (SAWS 1) (9/90) CA 1/DFA
285-Al, or on the Important Information For Applicants and Recipients
For Cash Aid, Food Stamps and Medical Assistance (SAWS 2A) (5/92)
(Important Information) CA2/DFA 285-A2/MC 210, or on the State-
ment of Facts Cash and Food Stamps - (JA2) (4/90) CA2/DFA 285-A2
of his/her responsibility to report completely and accurately, facts re-
quired pursuant to Subdivision 1 , Chapter 2, which would affect eligibil-
ity or share or cost, and to report any changes in those facts within 10
days.
(2) A beneficiary or the person acting on the beneficiary's behalf has
completed and signed the Medi-Cal Applicant/Beneficiary Understand-
ing, MC 210 (9/91 ) cover sheet and the certification in the Statement of
Facts (Medi-Cal) MC 210 (3/92), or the certification in the Statement of
Facts Cash Aid and Food Stamps - (JA2) (4/90) CA2/DFA 2S5-A2, or
the certification in the Application for Cash Aid, Food Stamps, and/or
Medical Assistance (SAWS 1) (9/90) CAl/DFA 285-Al, or the certifi-
cation in the Important Information For Applicants and Recipients For
Cash Aid, Food Stamps and Medical Assistance (SAWS 2A) (5/92) (Im-
portant Information) CA2/DFA 285-A2/MC 210 and has, within his/her
competence, done any of the following:
(A) Provided incorrect oral or written information.
(B) Failed to provide information required pursuant to Subdivision 1,
Chapter 2, which would affect the eligibility or share of cost determina-
tion.
(C) Failed to report changes in circumstances regarding any informa-
tion required pursuant to Subdivision 1, Chapter 2, which would affect
eligibility or share of cost within 10 days of the change.
(3) These facts, when considered in conjunction with other informa-
tion available on the beneficiary's circumstances, would result in ineligi-
bility or an increased share of cost.
(b) If an increase occurred in a person's income or assets and that in-
crease would not have affected the person's eligibility or share of cost in
the month in which there was an increase in income or assets or in the fol-
lowing month because of the 10-day notice requirements specified in
Sections 50179, 50185 and 50653.5, no potential overpayment exists in
either such month.
(c) No potential overpayment exists if the beneficiary informed the
county department of circumstances which would result in ineligibility
or an increased share of cost, and the county department failed to act on
the information.
(d) No potential overpayment exists when there is a failure on the part
of a beneficiary to perform an act which is a condition of eligibility if the
failure is due to an error by the Department or the county department.
Page 386
Register 95, No. 14; 4-7-95
Title 22
Health Care Services
§ 50786
•
(e) For purposes of this section, potential overpayments shall be deter-
mined by applying the laws in effect in the month or months for which
the potential overpayment is being determined.
NOTE; Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 11004, 14009 and 14016.4, Welfare and Institutions
Code.
History
1 . Repealer and new section filed 12-30-8 1 as an emergency ; effective upon filing
(Register 82, No. 1 ). A Certificate of Compliance must be transmitted to OAL
within 120 days or emergency language will be repealed on 4-29-82.
2. Certificate of Compliance transmitted to OAL 4-23-82 and filed 5-12-82
(Register 82, No. 20).
3. New subsection (a)(3) and amendment of subsection (c) filed 5-12-82; effec-
tive thirtieth day thereafter (Register 82, No. 20).
4. Amendment of section and Note filed 4-13-93; operadve 5-13-93 (Resister
93, No. 16).
§ 50781 .5. Potential Overpayments — Unreported Other
Health Coverage.
(a) A potential overpayment occurs when a beneficiary, or the person
acting on the beneficiary's behalf, has knowingly failed to report other
health coverage under either of the following circumstances:
(1) The other health coverage is of a type designated by the Depart-
ment as not subject to post-service reimbursement, and the beneficiary
who fails to utilize such other health coverage without good cause; or
(2) The beneficiary has received services for which Medi-Cal paid,
and the beneficiary also claimed and received payment through private
health care coverage.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Secfions 14009, 14016.4 and 14024, Welfare and Institutions
Code.
History
1. New section filed 4-13-93; operafive 5-13-93 (Register 93, No. 16).
§ 50782. Fraud.
Fraud occurs if an overpayment occurs and the beneficiary or the per-
son acting on the beneficiary' s behalf willfully failed to report facts as
specified in Section 50781(a) with the intention of deceiving the Depart-
ment, the county department or the Social Security Administration for
the purpose of obtaining Medi-Cal benefits to which the beneficiary was
not entitled.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 11004, 14009, 14014and 14016.4, Welfare and Institu-
tions Code.
History
1. Amendment filed 12-30-81 as an emergency; effective upon filing (Register
82, No. 1 ). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 4-29-82.
2. Certificate of Compliance transmitted to OAL 4-23-82 and filed 5-12-82
(Register 82, No. 20).
3. Amendment of section and Note filed 4-13-93; operative 5-13-93 (Register
93, No. 16).
§ 50783. County Action on Potential Overpayment.
(a) The county department shall take the following action when it ap-
pears that there may be a potential overpayment:
(1) Determine the correct eligibility status and share of cost based on
the correct income, property and other circumstances.
(2) Determine whether a potential overpayment exists in accordance
with Section 50781.
(3) If a potential overpayment exists, refer it to the Department or to
the county unit contracting with the Department to collect overpayments
in accordance with the procedures established by the Department.
(4) In those instances where the potential overpayment is due to the
willful failure to report facts and there was a person acting on behalf of
the beneficiary:
(A) Determine whether the beneficiary is competent to handle his/her
own affairs.
(B) If the beneficiary is competent, require that the beneficiary act on
his/her own behalf in the future.
(C) If the beneficiary is not competent, refer the case to Social Services
and/or the public guardian or conservator to ensure that the beneficiary's
interests are protected.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Insfitutions
Code; Section 133.5, Chapter 102, Statutes of 1981 . Reference: Sections 1 1004,
14009 and 14016.4, Welfare and Instilufions Code.
History
1 . Repealerand new secfion filed 1 2-30-81 as an emergency; effective upon filing
(Register 82, No. 1). A Certificate of Compliance must be transmitted to OAL
within 120 days or emergency language will be repealed on 4-29-82.
2. Certificate of Compliance transmitted to OAL 4-23-82 and filed 5-12-82
(Register 82, No. 20).
§ 50785. Action on Overpayment — Department of Health.
NOTE; Authority cited: Secfion 10725 and 14124.5, Welfare and Insfitutions
Code; Section 133.5. Chapter 102, Statutes of 1981. Reference: Sections 1 1004,
14009 and 14016.4, Welfare and Institufions Code.
History
1. Repealer filed 12-30-81 as an emergency; effective upon filing (Register 82,
No. 1). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 4-29-82.
2. Certificate of Compliance transmitted to OAL 4-23-82 and filed 5-12-82
(Register 82, No. 20).
§ 50786. Action on Overpayment — Department of Health
Services or County Unit Contracted to Collect
Overpayments.
(a) Upon receipt of a potential overpayment referral, the Department's
Recovery Section or the county unit contracted to collect overpayments
shall:
(1 ) Determine the amount of Medi-Cal benefits received by the bene-
ficiary for the period in which there was a potential overpayment.
(2) Compute the actual overpayment in accordance with the follow-
ing:
(A) When the potential overpayment was due to excess property, the
actual overpayment shall be the lesser of the:
1 . Actual cost of services paid by the Department during that period
of consecutive months in which there was excess property throughout
each month.
2. Amount of property in excess of the property limit during that period
of consecutive months in which there was excess property throughout
each month. This excess amount shall be determined as follows:
a. Compute the excess property at the lowest point in the month for
each month.
b. The highest monthly amount determined in a. shall be the amount
of the excess property for the entire period of consecutive months.
(B) When the potential overpayment was due to increased share of
cost, the actual overpayment shall be the lesser of the:
1 . Actual cost of services received in the month(s) which were paid by
the Department.
2. Amount of the increased share of cost for the month(s) in which ser-
vices were received which were paid by the Department.
(C) When the overpayment was due to excess property and increased
share of cost, the actual overpayment shall be a combination of (A) and
(B).
(D) When the potential overpayment was due to other factors which
result in ineligibility the overpayment shall be the actual cost of services
paid by the Department.
(E) Potential overpayments, due to beneficiary possession of other
health coverage that is not subject to post-services reimbursement, shall
be processed by the Department to determine and recover actual over-
payments in all cases. The actual overpayment in such cases shall be the
actual cost of services paid by the Department which would have been
covered by private health insurance or other health coverage, had the
coverage been known to the Department. The actual overpayment shall
not include any costs which can be recovered directly by the Department
from the health insurance carrier or other source.
(3) Refer those cases where there appears there may be fraud to the In-
vestigations Branch of the Department.
(4) Take appropriate action to collect overpayments in accordance
with Section 50787.
Page 386.1
Register 94, No. 40; 10-7-94
§ 50787
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 1 1004, 14005.9. 14009 and 14016.4, Welfare and Insti-
tutions Code.
History
1. Amendment filed 12-30-81 as an emergency; effective upon filing (Register
82, No. 1). ACertificateofCompliancemustbe transmitted to OAL within 120
days or emergency language will be repealed on 4-29-82.
2. Certificate of Compliance transmitted to OAL 4-23-82 and filed 5-12-82
(Register 82, No. 20).
3. Amendment filed 5-12-82; effective thirtieth day thereafter (Register 82. No.
20).
4. Amendment of subsection (a)(2)(A)2. filed 6-3-87; operative 7-3-87 (Register
87, No. 24).
5. Amendment of subsections (a)(2)(B)l. and 2. and Note filed 4-13-93; opera-
tive 5-13-93 (Register 93, No. 16).
§ 50787. Demand for Repayment.
(a) The Department or the county unit contracted to collect overpay-
ments shall demand repayment of actual overpayments in accordance
with procedures established by the Department.
(b) The Department or the county unit contracted to collect overpay-
ments shall inform the beneficiary, or the person acting on the beneficia-
ry's behalf, in writing, of the overpayment amount and of his/her right
to a state hearing on the overpayment in accordance with Section 50951 .
If the person requests a state hearing on the overpayment, collection ac-
tion shall be suspended until a final decision has been rendered in accor-
dance with Section 50953.
(c) The Department or the county unit contracted to collect overpay-
ments may take other collection actions as permitted under state law
against the income or resources of the beneficiary or the income and re-
sources of any person who is financially responsible for the cost of the
beneficiary's health care in accordance with Sections 50088, 50163, and
50185.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 1 1004, 14009, 14014, 14016.4 and 14024, Welfare and
Institutions Code.
History
1. Amendment filed 12-30-81 as an emergency; effecfive upon filing (Register
82, No. 1). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 4-29-82.
2. Certificate of Compliance transmitted to OAL 4-23-82 and filed 5-12-82
(Register 82, No. 20).
3. New subsection (b) and subsection relettering. and amendment of newly desig-
nated subsection (c) and Note filed 4-13-93; operative 5-13-93 (Register 93,
No. 16).
§ 50789. Failure to Repay.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Institutions
Code; Section 133.5, Chapter 102, Statutes of 1981. Reference: Secfions 11004,
14009 and 14016.4, Welfare and Institutions Code.
History
1. Repealer filed 12-30-81 as an emergency effective upon filing (Register 82,
No. 1). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 4-29-82.
2. Certificate of Compliance transmitted to OAL 4-23-82 and filed 5-12-82
(Register 82, No. 20).
§ 50791 . Medi-Cal Overpayments Fraud— AFDC Cash
Grant.
(a) When an AFDC overpayment occurs, the county department shall:
(1) Investigate any potential Medi-Cal fraud which is incidental to
AFDC cash grant fraud and take appropriate action.
(2) Determine whether there was ineligibility for Medi-Cal as an
AFDC recipient. If so, the county shall determine whether:
(A) Medi-Cal eligibility existed under any other program.
(B) There was a potential Medi-Cal overpayment.
(C) Report potential Medi-Cal overpayments to the county unit desig-
nated to collect Medi-Cal overpayments caused by AFDC recipients.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Insfitutions
Code; Section 133.5, Chapter 102, Statutes of 1981 . Reference: Secfions 1 1004,
14009 and 14016., Welfare and Insfitufions Code.
HtSTORY
1. Amendment filed 12-30-81 as an emergency; effective upohi filing (Register
82, No. 1). A Certificate ofCompliance must be transmitted to OAL within 120
days or emergency language will be repealed on 4-29-82.
2. Certificate of Compliance transmitted to OAL 4-23-82 and filed 5-12-82
(Register 82, No. 20).
3. Amendment of subsection (a)(2)(C) filed 5-12-82; effective thirtieth day there-
after (Register 82, No. 20).
§ 50793. Utilization Restrictions.
(a) A beneficiary who has been determined by the Department to be
misusing or abusing Medi-Cal benefits by obtaining drugs or other ser-
vices at a frequency or amount not medically necessary may be subjected
to one or more of the following forms of utilization restriction:
(1 ) Prior authorization for all Medi-Cal services.
(2) Prior authorization for specific Medi-Cal services.
(3) Restriction to utilization of a specific, beneficiary- or Department-
selected pharmacy.
(4) Restriction to a specific, beneficiary- or Department-selected pri-
mary provider of medical services.
(b) Utilization restriction shall not apply in the following situations:
(1) Emergencies as defined in Section 51056.
(2) Referral of the restricted beneficiary to another provider by the
beneficiary- or Department-selected primary provider of medical ser-
vices.
(c) The Department shall impose utilization restriction upon a benefi-
ciary only on the written order of the Director or the Director's designee.
The written order, hereinafter referred to as the Notice of Action, shall:
(1) Include the reasons for the action.
(2) State the dates of the restriction period.
(3) Explain the beneficiary's right to and procedures for requesting a
hearing.
(4) Be mailed to the beneficiary by regular mail at least ten days prior
to the effective date.
(d) The restriction as described in (a) above shall be for a period of two
(2) years from the effective date on the Notice of Action.
(e) Should the Department find during the term of the restriction that
the potential for abuse still exists, so as to warrant continued restriction
beyond the two (2) year period, the Department may extend the period
of restriction. Each such extension shall:
(1) Be for an additional period of two (2) years.
(2) Require a separate Notice of Action in accordance with (c) above
except that the Notice of Action must be mailed at least ninety (90) days
prior to the effective date of the action.
(f) Should the beneficiary's request for a hearing be received prior to
the effective date of the action:
(1) Said action will not be taken until the hearing has been held and a
final decision rendered.
(2) The effective date of the action will be the first day of the month
following the adoption, by the Director, of the final hearing decision, pro-
vided the notice of decision was mailed at least ten (10) days prior to the
effective date of the action.
(g) Should the beneficiary's request for a hearing be received on or
subsequent to the effective date of the action, said action will remain in
full force and effect until the hearing has been held and a final decision
rendered.
(h) Under no circumstances shall the months wherein a beneficiary is
off restricted status solely due to requesting a hearing be counted toward
the two year period as provided for in (d) or (e) above.
(i) There is no right to a hearing when a beneficiary is placed on re-
stricted status as a result of his or her conviction of any misdemeanor or
felony involving fraud or abuse of medical assistance benefits or services
or in connection with any public assistance program.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Insfitufions
Code. Reference: Section 14124.5, Welfare and Institutions Code.
History
1. Amendment filed 8-16-78 as an emergency; designated effective 8-16-78
(Register 78, No. 32).
Page 386.2
Register 94, No. 40; 10-7-94
Title 22
Health Care Services
§ 50809
2. Certificate of Compliance filed 12-12-78 (Register 78, No. 50).
3. Amendment filed 6-22-87; operative 7-22-87 (Register 87, No. 28).
Article 17. Dialysis Medi-Cal Program
§ 50801. Medi-Cal Special Treatment Programs — General.
For the purposes of determining eligibility for Medi-Cal Special
Treatment Programs, the regulations in this article shall supersede any
conflicting regulations in this chapter.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14141, 14142, 14143, 14144 and 14144.5, Welfare and
Institutions Code.
History
1 . Amendment filed 5-16-80 as an emergency; effective upon filing (Register 80,
No. 20). A Certificate of Compliance must be transmitted to OAH within 120
days or emergency language will be repealed on 9-14-80.
2. Certificate of Compliance filed 8-22-80 (Register 80, No. 34).
3. Amendment filed 3-25-81 as an emergency; effective upon filing (Register 81 ,
No. 13). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 7-23-81.
4. Order of Repeal of 3-25-81 emergency order filed 4-3-81 by OAL pursuant
to Government Code Secfion 1 1349.6 (Register 81, No. 14).
5. Amendment filed 7-19-82; effective thirtieth day thereafter (Register 82, No.
30).
6. Editorial correction of NOTE filed 1 1-10-83 (Register 83, No. 46).
§ 50803. Medi-Cal Special Treatment Programs
Beneficiary.
(a) Medi-Cal Special Treatment Programs beneficiary means a person
who is either a Medi-Cal Special Treatment Programs — Only beneficia-
ry or a Medi-Cal Special Treatment Programs — Suppleinent beneficia-
ry.
(1) Medi-Cal Special Treatment Programs — Only beneficiary means
a person who has been determined eligible for Medi-Cal Special Treat-
ment Programs — Only coverage in accordance with Section 50817(b).
(2) Medi-Cal Special Treatment Programs — Supplement beneficiary
means a person who is a Medi-Cal Medically Needy or Medically Indi-
gent beneficiary and who has been determined eligible for the Medi-Cal
Special Treatment Programs — Supplement coverage in accordance with
Section 50817(c).
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14005.4, 14005.7, 14141, 14142, 14143, 14144 and
14144.5, Welfare and Insfitutions Code.
History
Amendment filed 5-16-80 as an emergency; effective upon filing (Register 80,
No. 20). A Certificate of Compliance must be transmitted to OAH within 120
days or emergency language will be repealed on 9-14-80.
Certificate of Compliance filed 8-22-80 (Register 80, No. 34).
Amendment filed 3-25-81 as an emergency; effective upon filing (Register 81 ,
No. 13). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 7-23-81.
4. Order of Repeal of 3-25-81 emergency order filed 4-3-81 by OAL pursuant
to Government Code Section 1 1349.6 (Register 81, No. 14).
5. Amendment filed 7-19-82; effective thirtieth day thereafter (Register 82, No.
30).
6. Editorial correction of NOTE filed 1 1-10-83 (Register 83, No. 46).
§ 50805. Real Property— Medi-Cal Special Treatment
Programs
Real property means any interest in land and improvements.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14140, 14141, 14142. 14143, 14144 and 14144.5, Wel-
fare and Insfitutions Code.
History
1. Amendment filed 5-16-80 as an emergency; effective upon filing (Register 80,
No. 20). A Certificate of Compliance must be transmitted to OAH within 120
days or emergency language will be repealed on 9-14-80.
2. Certificate of Compliance filed 8-22-80 (Register 80, No. 34).
3. Amendment filed 3-25-81 as an emergency; effecfive upon filing (Register 81 ,
No. 13). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 7-23-81.
4. Order of Repeal of 3-25-81 emergency order filed 4-3-81 by OAL pursuant
to Government Code Section 1 1349.6 (Register 81, No. 14).
5. Amendment of section heading filed 7-19-82; effecfive thirtieth day thereafter
(Register 82, No. 30).
6. Editorial correcfion of NOTE filed 1 1-10-83 (Register 83, No. 46).
§ 50807. Personal Property — Medi-Cal Special Treatment
Programs.
Personal property means cash, savings accounts, securities and similar
items; notes, mortgages and deeds of trust; the cash surrender value of life
insurance on the life of the beneficiary, spouse or any member of the fam-
ily; motor vehicles; and any other property or equity other than real prop-
erty.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Insfitutions
Code. Reference: Sections 14140, 14141, 14142, 14143, 14144 and 14144.5, Wel-
fare and Institutions Code.
History
1. Amendment filed 5-16-80 as an emergency; effective upon filing (Register 80,
No. 20). A Certificate of Compliance must be transmitted to OAH within 120
days or emergency language will be repealed on 9-14-80.
2. Certificate of Compliance filed 8-22-80 (Register 80, No. 34).
3. Amendment filed 3-25-81 as an emergency; effective upon filing (Register 81 ,
No. 13). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 7-23-81.
4. Order of Repeal of 3-25-81 emergency order filed 4-3-81 by OAL pursuant
to Government Code Secnon 11349.6 (Register 81, No. 14).
5. Amendment of section heading filed 7-19-82; effecfive thirtieth day thereafter
(Register 82, No. 30).
6. Editorial correction of NOTE filed 1 1-10-83 (Register 83, No. 46).
§ 50809. Gross Income — Medi-Cal Special Treatment
Programs.
Gross income means adjusted annual gross income as used for pur-
poses of federal income tax reporting.
NOTE: Authority cited: Secfions 10725 and 14124.5, Welfare and Insfitufions
Code. Reference: Secfions 14140, 14141, 14142, 14143, 14144 and 14144.5, Wel-
fare and Institutions Code.
History
1 . Amendment filed 5-16-80 as an emergency; effective upon filing (Register 80,
No. 20). A Certificate of Compliance must be transmitted to OAH within 120
days or emergency language will be repealed on 9-14-80.
2. Certificate of Compliance filed 8-22-80 (Register 80, No. 34).
3. Amendment filed 3-25-81 as an emergency; effecfive upon filing (Register 81,
No. 13). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 7-23-81.
4. Order of Repeal of 3-25-81 emergency order filed 4-3-81 by OAL pursuant
to Government Code Section 11349.6 (Register 81, No. 14).
5. Amendment of section heading filed 7-19-82; effecfive thirtieth day thereafter
(Register 82, No. 30).
6. Editorial cortecfion of NOTE filed 1 1-10-83 (Register 83, No. 46).
[The next page is 387.]
Page 386.3
Register 94, No. 40; 10-7-94
Title 22
Health Care Services
§ 50819
§ 5081 1 . Annual Net Worth.
Annual net worth means the total market value of all property and
gross income received for a 12-month period by the applicant or benefi-
ciary, in accordance with Section 50825.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14141, 14142, 14143, 14144 and 14144.5, Welfare and
Institutions Code.
History
1 . Editorial con'ection adding NOTE filed 1 1-10-83 (Register 83, No. 46).
§50813. Percentage Obligation.
Percentage obligation means the percent of the cost of dialysis or pa-
renteral hyperalimentation and related services for which a Medi-Cal
Special Treatment Programs beneficiary must either pay or assume full
legal responsibility.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institutions
Code. Reference: Sections 14141, 14142, 14143, 14144 and 14144.5, Welfare and
Institutions Code.
History
1 . Amendment filed 5-1 6-80 as an emergency; effective upon filing (Register 80,
No. 20). A Certificate of Compliance must be transmitted to OAH within 120
days or emergency language will be repealed on 9-14-80.
2. Certificate of Compliance filed 8-22-80 (Register 80, No. 34).
3. Amendment filed 3-25-81 as an emergency; effective upon filing (Register 81 ,
No. 13). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 7-23-81.
4. Order of Repeal of 3-25-81 emergency order filed 4-3-81 by OAL pursuant
to Government Code Section 1 1349.6 (Register 81, No. 14).
5. Amendment filed 7-19-82; effective thirtieth day thereafter (Register 82, No.
30).
6. Editorial correction of NOTE filed 1 1-10-83 (Register 83, No. 46).
§ 50815. Application Process — Medi-Cal Special
Treatment Programs.
(a) The county department shall receive and act on apphcations for the
Medi-Cal Special Treatment Programs in accordance with Article 4.
(1) The Application for Public Social Services, Form CA 1, shall be
used as the application form.
(2) The name of the applicable Medi-Cal Special Treatment Program
shall be indicated immediately above the "Medi-Cal card" box on Form
CAl.
(b) The county, in addition to meeting the requirements of Section
50157(1) and (g), shall provide Medi-Cal Special Treatment Pro-
grams — Supplement applicants a copy of the applicable Medi-Cal Spe-
cial Treatment Programs — Supplement Client Information statement at
the initial and redetermination or reapplication interviews. A signed and
dated copy of the applicable Medi-Cal Special Treatment Pro-
grams — Supplement Client Information statement shall be placed in the
case folder.
(c) A redetermination shall be required annually.
(d) The county department shall require Medi-Cal Special Treatment
Programs — Only and Medi-Cal Special Treatment Programs — Supple-
ment beneficiaries to complete a Medi-Cal Status Report, Form MC
176S, no later than the third month following the month of Medi-Cal
Special Treatment Programs eligibility approval and at three month in-
tervals thereafter. Status reports shall not be required during the quarter
in which an annual redetermination is completed.
(1) A reevaluation shall be made when a change in circumstances af-
fects the percentage obligation or eligibility.
(2) Information supplied on the status report shall be considered in re-
evaluating percentage obligation or eligibility.
(e) Retroactive eligibility, as defined by Section 50710, shall not be
provided under the Medi-Cal Special Treatment Programs.
NOTE: Authority cited: Secdons 10725 and 14124.5, Welfare and Institutions
Code. Reference: Secfions 14005.4, 14005.7, 14141, 14142, 14143, 14144 and
14144.5, Welfare and Institutions Code.
History
1 . Amendment filed 5-1 6-80 as an emergency; effective upon filing (Register 80,
No. 20). A Certificate of Compliance must be transmitted to OAH within 120
days or emergency language will be repealed on 9-14-80.
2. Certificate of Compliance filed 8-22-80 (Register 80, No. 34).
3. Amendment of subsection (d) filed 10-3-80; effective thirtieth day thereafter
(Register 80, No. 40).
4. Amendment filed 3-25-81 as an emergency; effective upon filing (Register 81 ,
No. 13). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 7-23-81.
5. Order of Repeal of 3-25-81 emergency order filed 4-3-81 by OAL pursuant
10 Government Code Section 11 349.6 (Register 81, No. 14).
6. Amendment filed 7-19-82; effective thirtieth day thereafter (Register 82, No.
30).
7. Editorial conection of NOTE filed 1 1-10-83 (Register 83, No. 46).
§ 50817. Eligibility Requirements — Medi-Cal Special
Treatment Programs.
(a) Applicants for Medi-Cal Special Treatment programs shall meet
cooperation, citizenship, residence, institutional status and transfer of
property requirements in Article 4, 6 and 9.
(b) Applicants shall be eligible for Medi-Cal Special Treatment Pro-
grams — Only coverage if they are all of the following:
(1) In need of dialysis or parenteral hyperalimentation and related ser-
vices.
(2) Otherwise eligible for Medi-Cal under Section 50203 as Medical-
ly Needy or Section 50251 as Medically Indigent except for property
which exceeds the limits set forth in Article 9.
(3) Not eligible for renal dialysis Medicare if under 65 years of age.
Medicare eligibility shall not affect Medi-Cal Special Treatment Pro-
grams — Only eligibility for persons age 65 or for persons applying for
parenteral hyperalimentation coverage.
(c) Applicants shall be eligible for the Medi-Cal Special Treatment
Programs — Supplement coverage if they are all of the following:
( 1 ) Eligible under Section 50203 as Medically Needy or Section 5025 ]
as Medically Indigent. Medicare eligibility shall not affect Medi-Cal
Special Treatment Programs — Supplement eligibility.
(2) In need of dialysis or parenteral hyperalimentation and related ser-
vices.
(3) Employed or self-employed.
(4) Earning an individual gross income that exceeds the minimum
maintenance need for one person.
(d) Applicants for the Medi-Cal Special Treatment Programs shall ap-
ply for Medicare as follows:
(1) Applicants for dialysis coverage shall apply for Medicare within
ten days of making application for a Medi-Cal Special Treatment Pro-
gram. Applicants who fail to apply for Medicare within the prescribed
time period, except for good cause as exemplified under Section 50175
(c), shall have the application denied under that specific Medi-Cal Spe-
cial Treatment Program.
(2) Applicants for or beneficiaries of parenteral hyperalimentation
coverage shall apply for Medicare in accordance with Section 50777.
NOTE: Authority cited: Sections 10725 and 14124.5, Welfare and Institufions
Code. Reference: Sections 14005.4, 14005.7, 14015, 14141, 14142, 14143, 14144
and 14144.5, Welfare and Insdtutions Code.
History
1 . Amendment filed 5-16-80 as an emergency; effective upon filing (Register 80,
No. 20). A Certificate of Compliance must be transmitted to OAH within 120
days or emergency language will be repealed on 9-14-80.
2. Certificate of Compliance filed 8-22-80 (Register 80, No. 34).
3. Amendment filed 3-25-81 as an emergency; effecfive upon filing (Register 81 ,
No. 13). A Certificate of Compliance must be transmitted to OAL within 120
days or emergency language will be repealed on 7-23-81 .
4. Order of Repeal of 3-25-81 emergency order filed 4-3-81 by OAL pursuant
to Government Code Section 11349.6 (Register 81, No. 14).
5. Amendment filed 7-19-82; effective thirtieth day thereafter (Register 82, No.
30).
6. Editorial correction of NOTE filed 1 1-10-83 (Register 83, No. 46).
7. Amendment of subsections (b)(2) and (b)(3) filed 6-3-87; operative 7-3-87
(Register 87, No. 24).
§ 50819. Verification Requirements — Medi-Cal Special
Treatment Programs.
(a) All Medi-Cal Special Treatment Program applicants or beneficia-
ries shall provide the following:
Page 387
Register 97, No. 37; 9-12-97
§ 50820
BARCLAYS CALIFORNIA CODE OF REGULATIONS
Title 22
(1) Applicable verification required under Article 4.
(2) A copy of the Social Security statement of Medicare status to the
county department within ten days of receipt.
(b) Dialysis Program beneficiaries shall provide verification of Medi-
care status at the following times:
(1) Annual redetermination, if previous verification does no 
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